Migraine, estrogen related

Posted On April 10, 2020

If migraine frequently recurs during a specific period of the menstrual cycle, or become worse during menopause, then estrogen related migraine needs to be considered. The treatment approach is different from the regular migraine.

Hormone related migraine, mechanism and treatment

  • Decline in estrogen
    • Beginning of menstrual cycle
    • Postpartum
    • Scheduled withdraw from contraceptives
    • Missing estrogen medication
  • Abortive treatment
    • Triptan
    • NSAID – Naprosyn 500 mg q 12
  • Preventive
    • Life style modification
      • avoid skipped meals
      • NSAID: Naprosyn 500 mg bid, beginning 7 days before menses, continue for 13 days
      • Tryptan: start 2 days before mens, continue for 5 or more days
        • Frovatriptan 2.5 mg qd or bid or
        • naratriptan 1 mg daily or
        • zolmitriptan 2.5 mg bid
      • magnesium 120 mg tid starting 15thth day of cicle may help
    • If above failed, consider
      • extended cycle estrogen-progestin cycle contraceptive or use of
      • estrogen patch 0.1 mg/24 hr during the estrogen free period of contraceptive

Headache.org – patient guide to menstrual headache

Migraine diary

  • Printable forms
  • Or record the following on any calendar
    • Date:
    • Location: area of maximal pain
    • character: pounding, pressure, electric shock
    • duration: in minutes or hours
    • Severity: scale of 1-10