Estrogen-associated migraine

INTRODUCTION

A decline in estrogen concentration is an important factor in triggering migraine in women [1]. Estrogen-associated migraine refers to migraine headaches that occur when there is a decline in estrogen concentration after exposure to high levels of the hormone for several days (estrogen priming), as in the following settings [2,3]:

Natural declines in endogenous estrogen, such as at the beginning of the menstrual cycle (figure 1) or postpartum.

Scheduled withdrawal from exogenous estrogen-containing products, such as during the hormone-free interval in users of cyclic estrogen-progestin contraceptives (pills, transdermal patch, ring) or with interruptions in estrogen therapy.

Unintentional estrogen withdrawal, such as from missed doses of estrogen-containing drugs or as a result of drug interactions that reduce availability.

Estrogen-associated migraine, primarily menstrual migraine, will be reviewed here. The pathophysiology, clinical manifestations and diagnosis of migraine and treatment of nonestrogen-withdrawal migraine are discussed separately. (See "Pathophysiology, clinical manifestations, and diagnosis of migraine in adults" and "Acute treatment of migraine in adults".)

                                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2014. | This topic last updated: Mar 19, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Scharff L, Turk DC, Marcus DA. Triggers of headache episodes and coping responses of headache diagnostic groups. Headache 1995; 35:397.
  2. Somerville BW. Estrogen-withdrawal migraine. II. Attempted prophylaxis by continuous estradiol administration. Neurology 1975; 25:245.
  3. Somerville BW. Estrogen-withdrawal migraine. I. Duration of exposure required and attempted prophylaxis by premenstrual estrogen administration. Neurology 1975; 25:239.
  4. Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis--part I. Headache 2006; 46:3.
  5. Winner P, Ricalde O, Le Force B, et al. A double-blind study of subcutaneous dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine. Arch Neurol 1996; 53:180.
  6. Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis--part 2. Headache 2006; 46:365.
  7. Hellström B, Anderberg UM. Pain perception across the menstrual cycle phases in women with chronic pain. Percept Mot Skills 2003; 96:201.
  8. D'Amico JF, Greendale GA, Lu JK, Judd HL. Induction of hypothalamic opioid activity with transdermal estradiol administration in postmenopausal women. Fertil Steril 1991; 55:754.
  9. BILLE BS. Migraine in school children. A study of the incidence and short-term prognosis, and a clinical, psychological and electroencephalographic comparison between children with migraine and matched controls. Acta Paediatr Suppl 1962; 136:1.
  10. Waters WE, O'Connor PJ. Epidemiology of headache and migraine in women. J Neurol Neurosurg Psychiatry 1971; 34:148.
  11. Crawford MJ, Lehman L, Slater S, et al. Menstrual migraine in adolescents. Headache 2009; 49:341.
  12. Miro F, Parker SW, Aspinall LJ, et al. Sequential classification of endocrine stages during reproductive aging in women: the FREEDOM study. Menopause 2005; 12:281.
  13. MacGregor EA. Migraine headache in perimenopausal and menopausal women. Curr Pain Headache Rep 2009; 13:399.
  14. Neri I, Granella F, Nappi R, et al. Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas 1993; 17:31.
  15. Launer LJ, Terwindt GM, Ferrari MD. The prevalence and characteristics of migraine in a population-based cohort: the GEM study. Neurology 1999; 53:537.
  16. Wang SJ, Fuh JL, Lu SR, et al. Migraine prevalence during menopausal transition. Headache 2003; 43:470.
  17. Freeman EW, Sammel MD, Lin H, et al. Symptoms in the menopausal transition: hormone and behavioral correlates. Obstet Gynecol 2008; 111:127.
  18. Hodson J, Thompson J, al-Azzawi F. Headache at menopause and in hormone replacement therapy users. Climacteric 2000; 3:119.
  19. Sabia S, Fournier A, Mesrine S, et al. Risk factors for onset of menopausal symptoms: results from a large cohort study. Maturitas 2008; 60:108.
  20. Mattsson P. Hormonal factors in migraine: a population-based study of women aged 40 to 74 years. Headache 2003; 43:27.
  21. Granella F, Sances G, Zanferrari C, et al. Migraine without aura and reproductive life events: a clinical epidemiological study in 1300 women. Headache 1993; 33:385.
  22. Oldenhave A, Jaszmann LJ, Everaerd WT, Haspels AA. Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age. Am J Obstet Gynecol 1993; 168:765.
  23. Calhoun AH. Migraine and menopause. Headache 2004; 44:106; author reply 106.
  24. Tietjen GE, Bushnell CD, Herial NA, et al. Endometriosis is associated with prevalence of comorbid conditions in migraine. Headache 2007; 47:1069.
  25. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalagia 2004; 24:9.
  26. MacGregor EA, Hackshaw A. Prevalence of migraine on each day of the natural menstrual cycle. Neurology 2004; 63:351.
  27. Couturier EG, Bomhof MA, Neven AK, van Duijn NP. Menstrual migraine in a representative Dutch population sample: prevalence, disability and treatment. Cephalalgia 2003; 23:302.
  28. Visser WH, Jaspers NM, de Vriend RH, Ferrari MD. Risk factors for headache recurrence after sumatriptan: a study in 366 migraine patients. Cephalalgia 1996; 16:264.
  29. Stewart WF, Lipton RB, Chee E, et al. Menstrual cycle and headache in a population sample of migraineurs. Neurology 2000; 55:1517.
  30. Vetvik KG, Macgregor EA, Lundqvist C, Russell MB. Prevalence of menstrual migraine: a population-based study. Cephalalgia 2014; 34:280.
  31. Johannes CB, Linet MS, Stewart WF, et al. Relationship of headache to phase of the menstrual cycle among young women: a daily diary study. Neurology 1995; 45:1076.
  32. Ashkenazi A, Silberstein S. Menstrual migraine: a review of hormonal causes, prophylaxis and treatment. Expert Opin Pharmacother 2007; 8:1605.
  33. Pringsheim T, Davenport WJ, Dodick D. Acute treatment and prevention of menstrually related migraine headache: evidence-based review. Neurology 2008; 70:1555.
  34. Marcus DA, Bernstein CD, Sullivan EA, Rudy TE. Perimenstrual eletriptan prevents menstrual migraine: an open-label study. Headache 2010; 50:551.
  35. Al-Waili NS. Treatment of menstrual migraine with prostaglandin synthesis inhibitor mefenamic acid: double-blind study with placebo. Eur J Med Res 2000; 5:176.
  36. Mannix LK, Martin VT, Cady RK, et al. Combination treatment for menstrual migraine and dysmenorrhea using sumatriptan-naproxen: two randomized controlled trials. Obstet Gynecol 2009; 114:106.
  37. Cady RK, Diamond ML, Diamond MP, et al. Sumatriptan-naproxen sodium for menstrual migraine and dysmenorrhea: satisfaction, productivity, and functional disability outcomes. Headache 2011; 51:664.
  38. Calhoun A, Ford S. Elimination of menstrual-related migraine beneficially impacts chronification and medication overuse. Headache 2008; 48:1186.
  39. Sances G, Martignoni E, Fioroni L, et al. Naproxen sodium in menstrual migraine prophylaxis: a double-blind placebo controlled study. Headache 1990; 30:705.
  40. Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012; 78:1337.
  41. Newman L, Mannix LK, Landy S, et al. Naratriptan as short-term prophylaxis of menstrually associated migraine: a randomized, double-blind, placebo-controlled study. Headache 2001; 41:248.
  42. Silberstein SD, Elkind AH, Schreiber C, Keywood C. A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurology 2004; 63:261.
  43. Brandes JL, Poole Ac, Kallela M, et al. Short-term frovatriptan for the prevention of difficult-to-treat menstrual migraine attacks. Cephalalgia 2009; 29:1133.
  44. Tuchman MM, Hee A, Emeribe U, Silberstein S. Oral zolmitriptan in the short-term prevention of menstrual migraine: a randomized, placebo-controlled study. CNS Drugs 2008; 22:877.
  45. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991; 31:298.
  46. Brandes JL. The influence of estrogen on migraine: a systematic review. JAMA 2006; 295:1824.
  47. Calhoun, A. Four hypotheses for understanding menstrual migraine. The Female Patient 2004; 29:38.
  48. Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet 1996; 348:498.
  49. Chan WS, Ray J, Wai EK, et al. Risk of stroke in women exposed to low-dose oral contraceptives: a critical evaluation of the evidence. Arch Intern Med 2004; 164:741.
  50. Etminan M, Takkouche B, Isorna FC, Samii A. Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. BMJ 2005; 330:63.
  51. Petitti DB, Sidney S, Bernstein A, et al. Stroke in users of low-dose oral contraceptives. N Engl J Med 1996; 335:8.
  52. Schwartz SM, Petitti DB, Siscovick DS, et al. Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke 1998; 29:2277.
  53. ACOG Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol 2006; 107:1453.
  54. Calhoun A, Ford S, Pruitt A. The impact of extended-cycle vaginal ring contraception on migraine aura: a retrospective case series. Headache 2012; 52:1246.
  55. Calhoun A. Combined hormonal contraceptives: is it time to reassess their role in migraine? Headache 2012; 52:648.
  56. Sulak P, Willis S, Kuehl T, et al. Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 2007; 47:27.
  57. Sulak PJ, Scow RD, Preece C, et al. Hormone withdrawal symptoms in oral contraceptive users. Obstet Gynecol 2000; 95:261.
  58. Calhoun AH. A novel specific prophylaxis for menstrual-associated migraine. South Med J 2004; 97:819.
  59. Predalier, A, Vincent, D, Beaulieu, PH, et al. Correlation between oestradiol plasma level and therapeutic effect on menstrual migraine. In: New advances in headache research, Rose, FC, (Ed), 4th ed, Smith-Gordon, London 1994. p. 129.
  60. de Lignières B, Vincens M, Mauvais-Jarvis P, et al. Prevention of menstrual migraine by percutaneous oestradiol. Br Med J (Clin Res Ed) 1986; 293:1540.
  61. Dennerstein L, Morse C, Burrows G, et al. Menstrual migraine: a double-blind trial of percutaneous estradiol. Gynecol Endocrinol 1988; 2:113.
  62. MacGregor EA, Frith A, Ellis J, et al. Prevention of menstrual attacks of migraine: a double-blind placebo-controlled crossover study. Neurology 2006; 67:2159.
  63. Almén-Christensson A, Hammar M, Lindh-Åstrand L, et al. Prevention of menstrual migraine with perimenstrual transdermal 17-β-estradiol: a randomized, placebo-controlled, double-blind crossover study. Fertil Steril 2011; 96:498.
  64. O'Dea JP, Davis EH. Tamoxifen in the treatment of menstrual migraine. Neurology 1990; 40:1470.
  65. Murray SC, Muse KN. Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and "add-back" therapy. Fertil Steril 1997; 67:390.
  66. Lichten, EM, Lichten J, Whitty, A, Peiper, D. The use of leuprolide acetate in the diagnosis and treatment of menstrual migraine: The role of artificially induced menopause. Headache Q 1995; 6:313.
  67. Martin V, Wernke S, Mandell K, et al. Medical oophorectomy with and without estrogen add-back therapy in the prevention of migraine headache. Headache 2003; 43:309.
  68. Dlugi AM, Miller JD, Knittle J. Lupron depot (leuprolide acetate for depot suspension) in the treatment of endometriosis: a randomized, placebo-controlled, double-blind study. Lupron Study Group. Fertil Steril 1990; 54:419.
  69. Finocchi C, Ferrari M. Female reproductive steroids and neuronal excitability. Neurol Sci 2011; 32 Suppl 1:S31.
  70. Nappi RE, Sances G, Allais G, et al. Effects of an estrogen-free, desogestrel-containing oral contraceptive in women with migraine with aura: a prospective diary-based pilot study. Contraception 2011; 83:223.
  71. Somerville BW. The role of progesterone in menstrual migraine. Neurology 1971; 21:853.
  72. Misakian AL, Langer RD, Bensenor IM, et al. Postmenopausal hormone therapy and migraine headache. J Womens Health (Larchmt) 2003; 12:1027.
  73. Greendale GA, Reboussin BA, Hogan P, et al. Symptom relief and side effects of postmenopausal hormones: results from the Postmenopausal Estrogen/Progestin Interventions Trial. Obstet Gynecol 1998; 92:982.
  74. Facchinetti F, Nappi RE, Tirelli A, et al. Hormone supplementation differently affects migraine in postmenopausal women. Headache 2002; 42:924.
  75. Nappi RE, Cagnacci A, Granella F, et al. Course of primary headaches during hormone replacement therapy. Maturitas 2001; 38:157.
  76. Calhoun, AH. Women's Issues in Headache. In: Headache, Loder, E, (Ed), American College of Physicians, American Society of Internal Medicine 2004. p 157.
  77. Nand SL, Webster MA, Baber R, Heller GZ. Menopausal symptom control and side-effects on continuous estrone sulfate and three doses of medroxyprogesterone acetate. Ogen/Provera Study Group. Climacteric 1998; 1:211.
  78. Amir BY, Yaacov B, Guy B, et al. Headaches in women undergoing in vitro fertilization and embryo-transfer treatment. Headache 2005; 45:215.