Headache and female hormones: what you need to know

The normal female lifecycle is associated with hormonal milestones, includi ng menarche, pregnancy, contraceptive use, menopause, and the use of replac ement sex hormones. Attacks of migraine without aura, but not with aura, ar e more likely to occur 2 days before onset and on the first 2 days of mense s, but they are not more severe than those that occur outside the perimenst rual period. Oral sumatriptan and naratriptan are effective as short-term p erimenstrual prophylaxis. Postdural headache can occur during the postpartu m period. The International Headache Society Task Force assessed the effica cy of treatment of women who had migraine with combined oral contraceptives and hormone replacement therapy. as well as the risk of ischemic stroke as sociated with their use. There is no contraindication to the use of oral co ntraceptives in women with migraine in the absence of migraine aura or othe r risk factors. There is a potentially increased risk of ischemic stroke in women with migraine who are using combined oral contraceptives and have ad ditional risk factors that cannot easily be controlled, including migraine with aura. There is no compelling evidence that postmenopausal hormone repl acement therapy either decreases or increases stroke risk. Curr Opin Neurol 14:323-333. (C) 2001 Lippincott Williams & Wilkins.