Skip to main content

Advertisement

SpringerLink
Log in

Women and Migraine: the Role of Hormones

  • Headache (R Halker, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Migraine is a debilitating disease, that is encountered in countless medical offices every day and since it is highly prevalent in women, it is imperative to have a clear understanding of how to manage migraine. There is a growing body of evidence regarding the patterns we see in women throughout their life cycle and how we approach migraine diagnosis and treatment at those times.

Recent Findings

New guidelines regarding safety of medication during pregnancy and lactation are being utilized to help guide management decisions in female migraineurs. There is also new data surrounding the risk of stroke in individuals who suffer from migraine with aura.

Summary

This article seeks to provide an overview of a woman’s migraine throughout her lifetime, the impact of hormones and an approach to management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

MM:

Menstrual migraine

OCP:

Oral contraceptive pill

HRT:

Hormone replacement therapy

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Steiner T, Stovner L, Vos T. GBD 2015: migraine is the third cause of disability in under 50s. The Journal of Headache and Pain. 2016;17:104. https://doi.org/10.1186/s10194-016-0699-5.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2017;390:1211–859.

  3. (2018) Headache Classification Committee of the International Headache Society (IHS) The international classification of headache disorders, 3rd edition. Cephalalgia 38:1–211.

  4. Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13:177–89.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Stewart W. Prevalence of migraine headache in the United States. JAMA. 1992;267:64–9.

    Article  PubMed  CAS  Google Scholar 

  6. Stovner L, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210.

  7. Buse D, Loder E, Gorman J, Stewart W, Reed M, Fanning K, et al. Sex differences in the prevalence, symptoms, and associated features of migraine, probable migraine and other severe headache: results of the American Migraine Prevalence and Prevention (AMPP) study. Headache: J Head Face Pain. 2013;53:1278–99.

  8. Crawford M, Lehman L, Slater S, Kabbouche M, LeCates S, Segers A, et al. Menstrual migraine in adolescents. Headache: J Head Face Pain. 2009;49:341–7.

  9. Martin V, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis-part I. Headache: J Head Face Pain. 2006;46:3–23.

    Article  Google Scholar 

  10. •• Vetvik K, MacGregor E. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017;16:76–87. The authors review sex differences regarding migraine characteristics and treatment. This paper discusses the possible exogenous and endogenous hormonal influences on genes that lead to women experiencing more migraine than men.

    Article  PubMed  CAS  Google Scholar 

  11. Sacco S, Merki-Feld G, Ægidius K, et al. Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). J Headache Pain. 2017;18:108. https://doi.org/10.1186/s10194-017-0815-1.

    Article  PubMed  PubMed Central  Google Scholar 

  12. ACOG practice bulletin no. 73: use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol. 2006;107:1453.

  13. Cutrer F, Huerter K. Migraine aura. Neurologist. 2007;13:118–25.

    Article  PubMed  Google Scholar 

  14. • Calhoun A, Batur P. Combined hormonal contraceptives and migraine: an update on the evidence. Cleveland Clin J Med. 2017;84:631–8. This article highlights the issues around oral contraceptive use in women migraineurs with and without aura. It discusses the algorithm physicians should use in order to safely prescribe estrogen-containing contraceptives.

    Article  Google Scholar 

  15. •• Champaloux S, Tepper N, Monsour M, Curtis K, Whiteman M, Marchbanks P, et al. Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Obstet Gynecol Surv. 2017;72:543–5. This article finds a 6-fold increased risk of stroke in women of childbearing age who use combine oral contraceptive medications and suffer from migraine with aura.

  16. Tepper N, Whiteman M, Zapata L, Marchbanks P, Curtis K. Safety of hormonal contraceptives among women with migraine: a systematic review. Contraception. 2016;94:630–40.

    Article  PubMed  CAS  Google Scholar 

  17. Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13:177–89.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Tariq N, Tepper S, Kriegler J. Patent foramen ovale and migraine: closing the debate-a review. Headache: J Head Face Pain. 2016;56:462–78.

    Article  Google Scholar 

  19. Vetvik K, Benth J, MacGregor E, Lundqvist C, Russell M. Menstrual versus non-menstrual attacks of migraine without aura in women with and without menstrual migraine. Cephalalgia. 2015;35:1261–8.

    Article  PubMed  Google Scholar 

  20. Sullivan E, Bushnell C. Management of menstrual migraine: a review of current abortive and prophylactic therapies. Curr Pain Headache Rep. 2010;14:376–84.

    Article  PubMed  PubMed Central  Google Scholar 

  21. MacGregor E. Review: menstrual migraine: therapeutic approaches. Ther Adv Neurol Disord. 2009;2:327–36.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Calhoun A. Understanding menstrual migraine. Headache: J Head Face Pain. 2018;58:626–30. https://doi.org/10.1111/head.13291.

    Article  Google Scholar 

  23. Güven B, Güven H, Çomoğlu S. Clinical characteristics of menstrually related and non-menstrual migraine. Acta Neurologica Belgica. 2017;117:671–6.

    Article  PubMed  Google Scholar 

  24. MacGregor E. Migraine headache in perimenopausal and menopausal women. Curr Pain Headache Rep. 2009;13:399–403.

    Article  PubMed  Google Scholar 

  25. Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13:177–89.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Allais G, Chiarle G, Sinigaglia S, Airola G, Schiapparelli P, Bergandi F, et al. Treating migraine with contraceptives. Neurol Sci. 2017;38:85–9.

  27. Lay C, Broner S. Adolescent issues in migraine: a focus on menstrual migraine. Curr Pain Headache Rep. 2008;12:384–7.

    Article  PubMed  Google Scholar 

  28. Warhurst S, Rofe C, Brew B, Bateson D, McGeechan K, Merki-Feld G, et al. Effectiveness of the proestin-only pill for migraine treatment in women: a systematic review and meta-analysis. Cephalalgia. 2017;38:754–64.

  29. Neri I, Granella F, Nappi R, Manzoni G, Facchinetti F, Genazzani A. Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas. 1993;17:31–7.

    Article  PubMed  CAS  Google Scholar 

  30. Calhoun A. Hormonal contraceptives and migraine with aura-is there still a risk? Headache: J Head Face Pain. 2016;57:184–93.

    Article  Google Scholar 

  31. Lay C, Broner S. Migraine in women. Neurol Clin. 2009;27:503–11.

    Article  PubMed  Google Scholar 

  32. Jarvis S, Dassan P, Piercy C. Managing migraine in pregnancy. BMJ. 2018:k80.

  33. Pakalnis A. Migraine and hormones. Semin Pediatr Neurol. 2016;23:92–4.

    Article  PubMed  Google Scholar 

  34. Grossman T, Robbins M, Govindappagari S, Dayal A. Delivery outcomes of patients with acute migraine in pregnancy: a retrospective study. Headache: J Head Face Pain. 2017;57:605–11.

    Article  Google Scholar 

  35. Wells R, Turner D, Lee M, Bishop L, Strauss L. Managing migraine during pregnancy and lactation. Curr Neurol Neurosci Rep. 2016;16:40. https://doi.org/10.1007/s11910-016-0634-9.

    Article  PubMed  CAS  Google Scholar 

  36. • Negro A, Delaruelle Z, Ivanova T, Khan S, Ornello R, Raffaelli B, et al. Headache and pregnancy: a systematic review. J Headache Pain. 2017; https://doi.org/10.1186/s10194-017-0816-0. This article reviews the literature regarding the safety of pharmacological treatment of migraine during both the peri-partum and post-partum period. The authors update readers on the change in safety classifications.

  37. Nezvalová-Henriksen K, Spigset O, Nordeng H. The effects of codeine on pregnancy outcome: results from a large population-based cohort study. Reprod Toxicol. 2011;31:263–3.

  38. Marchenko A, Etwel F, Olutunfese O, Nickel C, Koren G, Nulman I. Pregnancy outcome following prenatal exposure to triptan medications: a meta-analysis. Headache: J Head Face Pain. 2015;55:490–501.

    Article  Google Scholar 

  39. Harris G, Wood M, Ystrom E, Nordeng H. Prenatal triptan exposure and neurodevelopmental outcomes in 5-year-old children: follow-up from the Norwegian mother and child cohort study. Paediatr Perinat Epidemiol. 2018; https://doi.org/10.1111/ppe.12461.

  40. Hoshiyama E, Tatsumoto M, Iwanami H, Saisu A, Watanabe H, Inaba N, et al. Postpartum migraines: a long-term prospective study. Intern Med. 2012;51:3119–23.

  41. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014;70:1313–24.

    Article  PubMed  CAS  Google Scholar 

  42. Hutchinson S, Marmura M, Calhoun A, Lucas S, Silberstein S, Peterlin B. Use of common migraine treatments in breast-feeding women: a summary of recommendations. Headache: J Head Face Pain. 2013;53:614–27.

    Article  Google Scholar 

  43. Ibrahimi K, Couturier E, MaassenVanDenBrink A. Migraine and perimenopause. Maturitas. 2014;78:277–80.

    Article  PubMed  Google Scholar 

  44. •• Martin V, Pavlovic J, Fanning K, Buse D, Reed M, Lipton R. Perimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache. J Head Face Pain. 2016;56:292–305. This is a cross-sectional study that reviews the frequency of headache during the various stages of menopause, particularly the perimenopausal period.

    Article  Google Scholar 

  45. Lauritsen C, Chua A, Nahas S. Current treatment options: headache related to menopause—diagnosis and management. Curr Treat Options Neurol. 2018;20 https://doi.org/10.1007/s11940-018-0492-7.

  46. Marino J, McNamara H, Hickey M. Managing menopausal symptoms after cancer: an evidence-based approach for primary care. Med J Aust. 2018;208:127–32.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Toronto Western Hospital, The University of Toronto, University Health Network, 399 Bathurst St. 5WW441, Toronto, ON, M5T 2S8, Canada

    Candice Todd

  2. Centre for Headache, Women’s College Hospital, The University of Toronto, 76 Grenville Street, 3rd floor, Toronto, ON, M5S 1B2, Canada

    Ana Marissa Lagman-Bartolome & Christine Lay

Authors
  1. Candice Todd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Marissa Lagman-Bartolome
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine Lay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine Lay.

Ethics declarations

Conflict of Interest

Candice Todd, Ana Marissa Lagman-Bartolome, and Christine Lay each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Headache

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Todd, C., Lagman-Bartolome, A.M. & Lay, C. Women and Migraine: the Role of Hormones. Curr Neurol Neurosci Rep 18, 42 (2018). https://doi.org/10.1007/s11910-018-0845-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-018-0845-3

Keywords

Search

Navigation