Abstract

Women have headaches more commonly than men. The prevalence of migraine is 18% of women and 6% of men. This gender ratio increases from menarche, peaks at middle age, and then declines. Estrogen levels are a key factor in the increased prevalence of migraine in women. Evidence includes the following: migraine prevalence increases at menarche; estrogen withdrawal during menstruation is a common migraine trigger; estrogen administration in oral contraceptives and hormone replacement therapy can trigger migraines; migraines typically decrease during the second and third trimesters of pregnancy when estrogen levels are high; migraines are common immediately post-partum with the precipitous drop in estrogen levels; and migraines generally improve with physiologic menopause. The biological basis, however, is not completely understood. This report will review some important headache issues for women including menstrual migraine, menopause and migraine, oral contraceptive use in migraineurs, and headaches during pregnancy and the postpartum.