[Female hormones and migraine]

Abstract

All the hormonal events of the female life may modify the course of the migrainous disease. Their influence is slightly different on migraine with and without aura. Development of migraine at menarche and menstrually-related migraine attacks are principally observed in migraine without aura. Percutaneous estradiol is often effective for the prevention of pure menstrual migraine. Migraine usually improves during pregnancy; a worsening or a first development of attacks may nevertheless occur during this period, especially for migraine with aura. Oral contraception is not contraindicated in most migraine sufferers; it may worsen, improve or leave unchanged their disease. Migraine represents a risk factor of ischaemic stroke in young women; though a low one, some caution is necessary: tobacco should be forbidden, and the use of low-dose estrogen pills is recommended. Oral contraceptives should be interrupted in case of worsening of migraine, especially with aura. Estrogen replacement therapy is allowed after menopause in migraine sufferers; it may sometimes exacerbate migraine, which is in most cases controlled by therapeutic adjustment.