There is much anecdotal evidence that migraine is associated with horm
onal changes, but the mechanism remains unknown. Research has been res
tricted by the lack of an agreed definition for ''menstrual'' migraine
, and a clinical definition is proposed. Studies suggest that estrogen
withdrawal may have an important role, such as occurs during the late
luteal phase of the normal menstrual cycle, during the ''pill-free''
week of the combined oral contraception, and during the treatment-free
week of cyclical estrogen replacement therapy. Furthermore, treatment
s that maintain stable high or low estrogen levels are associated with
benefit. Management strategies are presented for migraine associated
with different hormonal events.