MENSTRUATION, SEX-HORMONES, AND MIGRAINE

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.