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Hormone-related headache: pathophysiology and treatment.
CNS Drugs. 2006; 20(2):125-41.CD

Abstract

Epidemiological data suggest a link between migraine and the female sex hormones. Indeed, it is known that estrogen affects various brain functions, including pain perception. The prevalence of migraine is similar in boys and girls before puberty, but is 3-fold higher in postpubertal females compared with males. Migraine attacks in women are more likely to occur in the perimenstrual period and occur exclusively so in some women. The acute treatment of menstrual migraine is similar to that of non-menstrually related attacks, but the response to treatment may be less favourable. Perimenstrual prophylaxis, with NSAIDs, triptans or estradiol, is effective in decreasing attack frequency and severity. The use of oral contraceptives (OCs) may change migraine frequency and severity. Since both migraine and hormonal contraceptive use are risk factors for ischaemic stroke, the use of OCs in women who experience migraine should be made only after consideration of the benefit-risk ratio. Migraine typically, but not invariably, improves during the last two trimesters of pregnancy, and may worsen in the postpartum period. When using drugs to treat migraine during pregnancy, potential risks to the mother and fetus should be considered. The prevalence of migraine decreases with advancing age and it improves in many, but not all, women after the menopause. However, in the perimenopausal period, migraine may worsen as a result of fluctuations in estrogen levels. Reducing the estrogen dose and changing the estrogen type or the route of administration of hormone replacement therapy (HRT) from oral to transdermal may reduce headache. Migraine is not a risk factor for stroke in postmenopausal women. When considering symptomatic HRT for postmenopausal migraneurs, the usual indications and contraindications should be applied. HRT may also exacerbate migraine.

Authors+Show Affiliations

Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. avi.ashkenazi@jefferson.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

16478288

Citation

Ashkenazi, Avi, and Stephen D. Silberstein. "Hormone-related Headache: Pathophysiology and Treatment." CNS Drugs, vol. 20, no. 2, 2006, pp. 125-41.
Ashkenazi A, Silberstein SD. Hormone-related headache: pathophysiology and treatment. CNS Drugs. 2006;20(2):125-41.
Ashkenazi, A., & Silberstein, S. D. (2006). Hormone-related headache: pathophysiology and treatment. CNS Drugs, 20(2), 125-41.
Ashkenazi A, Silberstein SD. Hormone-related Headache: Pathophysiology and Treatment. CNS Drugs. 2006;20(2):125-41. PubMed PMID: 16478288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hormone-related headache: pathophysiology and treatment. AU - Ashkenazi,Avi, AU - Silberstein,Stephen D, PY - 2006/2/16/pubmed PY - 2006/6/9/medline PY - 2006/2/16/entrez SP - 125 EP - 41 JF - CNS drugs JO - CNS Drugs VL - 20 IS - 2 N2 - Epidemiological data suggest a link between migraine and the female sex hormones. Indeed, it is known that estrogen affects various brain functions, including pain perception. The prevalence of migraine is similar in boys and girls before puberty, but is 3-fold higher in postpubertal females compared with males. Migraine attacks in women are more likely to occur in the perimenstrual period and occur exclusively so in some women. The acute treatment of menstrual migraine is similar to that of non-menstrually related attacks, but the response to treatment may be less favourable. Perimenstrual prophylaxis, with NSAIDs, triptans or estradiol, is effective in decreasing attack frequency and severity. The use of oral contraceptives (OCs) may change migraine frequency and severity. Since both migraine and hormonal contraceptive use are risk factors for ischaemic stroke, the use of OCs in women who experience migraine should be made only after consideration of the benefit-risk ratio. Migraine typically, but not invariably, improves during the last two trimesters of pregnancy, and may worsen in the postpartum period. When using drugs to treat migraine during pregnancy, potential risks to the mother and fetus should be considered. The prevalence of migraine decreases with advancing age and it improves in many, but not all, women after the menopause. However, in the perimenopausal period, migraine may worsen as a result of fluctuations in estrogen levels. Reducing the estrogen dose and changing the estrogen type or the route of administration of hormone replacement therapy (HRT) from oral to transdermal may reduce headache. Migraine is not a risk factor for stroke in postmenopausal women. When considering symptomatic HRT for postmenopausal migraneurs, the usual indications and contraindications should be applied. HRT may also exacerbate migraine. SN - 1172-7047 UR - https://www.unboundmedicine.com/medline/citation/16478288/Hormone_related_headache:_pathophysiology_and_treatment_ L2 - https://dx.doi.org/10.2165/00023210-200620020-00004 DB - PRIME DP - Unbound Medicine ER -