Headache associated with hormonal fluctuations

Introduction
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By Christos Sidiropoulos MD and Panayiotis Mitsias MD

This clinical article includes discussion of  headaches related to menopause, menstruation, pregnancy, and oral contraceptives or birth control pills.  Migraine associated with menstrual periods is also known as Menstrual migraine and  Catamenial migraine. -ed.

In this clinical summary, Dr. Panayiotis Mitsias and Dr. Christos Sidiropoulos review the complex relations between headache and ovarian sex hormones in women. They discuss the changes in headache patterns during the major hormonal events (menarche, pregnancy, menopause) in the woman's life cycle and the effects of hormonal contraception and hormone replacement therapy on headache. Recent advances in elucidating the association between hormonal milieu and headache and new data on the possible mechanisms through which estrogen affects migraine and pain perception are presented. Therapeutic approaches and evidence-based practice regarding the management of menstrual migraine, migraine during pregnancy, and migraine in the perimenopausal and postmenopausal periods are analyzed. The potential complications and benefits of the use of hormonal contraceptives and hormone replacement therapy in women with migraine are also discussed based on evidence from recent clinical studies.