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Estrogen-associated migraine

Anne H Calhoun, MD, FAHS
Section Editors
Robert L Barbieri, MD
Jerry W Swanson, MD, MHPE
Deputy Editor
Kristen Eckler, MD, FACOG


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 sufficient 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 products or as a result of drug interactions that reduce bioavailability.

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".)

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Literature review current through: Nov 2017. | This topic last updated: May 30, 2017.
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