Migraine is most prevalent in women during their reproductive years. An understanding of the effects of menstruation and menopause on migraine can enable neurologists to provide targeted and appropriate medical and hormonal strategies, enabling their patients to achieve better control of migraine and reduced disability. This article reviews the effects of hormonal events on migraine and summarizes the evidence-based options available for management.
Estrogen “withdrawal” during the late luteal phase of the natural menstrual cycle and the hormone-free interval of combined hormonal contraceptives has long been implicated in the pathophysiology of menstrual migraine. However, more recent research suggests that other independent mechanisms may be relevant. Prostaglandin inhibitors used for management of dysmenorrhea are effective for associated menstrual migraine, suggesting a common pathophysiology. The interplay between serotonin and estrogen also deserves further research.
Menstrual and perimenopausal migraine can be managed effectively using a variety of strategies, the choice of which depends on the efficacy of acute treatment, predictability and regularity of menstruation, use of contraception, and presence of menstrual disorders or perimenopausal vasomotor symptoms.
Address correspondence to Dr E. Anne MacGregor, Barts Sexual Health Centre, St Bartholomew’s Hospital, London EC1A 7BE, United Kingdom, firstname.lastname@example.org.
Relationship Disclosure: Dr MacGregor has served as a consultant for the Menarini Group and received personal compensation for speaking engagements from Bayer HealthCare AG. Dr MacGregor receives royalties from Oxford University Press.
Unlabeled Use of Products/Investigational Use Disclosure: Dr MacGregor discusses the unlabeled/investigational of frovatriptan, naratriptan, and zolmitriptan for perimenstrual migraine prophylaxis.