CNS Drugs

, Volume 20, Issue 2, pp 125–141 | Cite as

Hormone-Related Headache

Pathophysiology and Treatment
  • Avi Ashkenazi
  • Stephen D. Silberstein
Therapy In Practice


Epidemiological data suggest a link between migraine and the female sex hormones. Indeed, it is known that estrogen affects various brain functions, including pain perception. The prevalence of migraine is similar in boys and girls before puberty, but is 3-fold higher in postpubertal females compared with males. Migraine attacks in women are more likely to occur in the perimenstrual period and occur exclusively so in some women. The acute treatment of menstrual migraine is similar to that of non-menstrually related attacks, but the response to treatment may be less favourable. Perimenstrual prophylaxis, with NSAIDs, triptans or estradiol, is effective in decreasing attack frequency and severity.

The use of oral contraceptives (OCs) may change migraine frequency and severity. Since both migraine and hormonal contraceptive use are risk factors for ischaemic stroke, the use of OCs in women who experience migraine should be made only after consideration of the benefit-risk ratio.

Migraine typically, but not invariably, improves during the last two trimesters of pregnancy, and may worsen in the postpartum period. When using drugs to treat migraine during pregnancy, potential risks to the mother and fetus should be considered.

The prevalence of migraine decreases with advancing age and it improves in many, but not all, women after the menopause. However, in the perimenopausal period, migraine may worsen as a result of fluctuations in estrogen levels. Reducing the estrogen dose and changing the estrogen type or the route of administration of hormone replacement therapy (HRT) from oral to transdermal may reduce headache. Migraine is not a risk factor for stroke in postmenopausal women. When considering symptomatic HRT for postmenopausal migraneurs, the usual indications and contraindications should be applied. HRT may also exacerbate migraine.


Migraine Hormone Replacement Therapy Sumatriptan Migraine Attack Migraine With Aura 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr Ashkenazi has received research support from and served as a speaker to Merck. Dr Silberstein is on the advisory panel, speakers’ bureau or serves as a consultant for Abbott, AGA, Allergan, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Medtronics, Merck, Pfizer and Pozen. He receives research support from Abbott, Advanced NeuroModulation Systems, Allergan, AstraZeneca, Eisai, Endo, Johnson & Johnson, Lilly, GlaxoSmithKline, OrthoMcNeil, Medtronics, Merck, NPS, Pfizer, Pozen, UCB Pharma and X-Cel Pharmaceuticals. No funding was used to assist in the preparation of this manuscript. The authors would like to thank Mrs Linda Algarin Kelly and Mrs Lynne Kaiser for their professional work in helping bring this manuscript to print.


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© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Department of NeurologyThomas Jefferson University HospitalPhiladelphiaUSA

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