Changes in estrogen levels at menarche, menstruation, pregnancy, and menopause may trigger or change the prevalence of migraine. The fall in estrogen that occurs with menstruation is the trigger for menstrual migraine, whereas the sustained high estrogen levels during pregnancy frequently result in headache relief. Estrogen produces changes in prostaglandins, hypothalmic opioids, and prolactin secretion, which may in part account for genesis of headache. The treatment of menstrual migraine and migraine associated with menopause and the use of oral contraceptives is discussed, focusing on standard headache treatment and hormonal manipulation.
PIP: Women tend to suffer more often from migraine than men (19% vs. 9%). Further menstruation is associated with attacks in 60% of women who have migraine. Moreover 14% of women with migraine suffer from attacks only with menses. Migraine may be linked to late luteal phase dysphoric disorder and dysmenorrhea. these conditions occur when the greatest fluctuation of estrogen levels occur. These fluctuations indeed cause prostaglandin levels to rise, prolactin release to intensify, and central nervous system opioid dysregulation to occur. In fact, several studies show that decreasing levels of estrogen activate menstrual migraine. Further estrogens and progesterone trigger synthesis of endometrial prostaglandins. In fact, prostaglandins regulate descending norepinephrine pain control systems in the brain, thus increased levels of prostaglandins decreases the pain threshold. In addition, falling levels of estrogens produce dopamine receptor hypersensitivity. Dopamine antagonists cause increased prolactin release throughout the luteal phase in all women and during the entire menstrual cycle in women with menstrual migraine. Physicians can treat menstrual migraine with various nonsteroidal antiinflammatory drugs, simple or combination analgesics, ergotamine, or hormonal therapy when other treatments fail. They should be aware that diuretics and pyridoxine are ineffective in treating menstrual migraine. Several replacement therapies to treat menopausal women with migraine exist. these include adding androgens, reducing estrogen dosage, converting to continuous dosing, and converting to parenteral dosing. Some data show an increase in or severity of migraine among oral contraceptive (OC) users, but other studies find no difference in headache among OC and placebo users. In fact, OCs may exacerbate, improve, or not change the frequency or severity of headaches.