Headache associated with hormonal fluctuations

Panayiotis Mitsias MD PhD (Dr. Mitsias of Henry Ford Hospital in Detroit, Michigan, has no relevant financial relationships to disclose.)
Stephen D Silberstein MD, editor. (

Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Allergan, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura,  INSYS Therapeutics, Lilly USA, Supernus Pharmacerticals,  Thernica and Trigemina for consulting. He is also the  principal investigator for a clinical trials conducted by Alder Biopharmaceuticals, Amgen, electroCore Medical, Lily USA and Teva.

Originally released November 23, 1993; last updated October 23, 2016; expires October 23, 2019

This article includes discussion of headache associated with hormonal fluctuations, acephalic migraine associated with hormonal fluctuations, basilar migraine associated with hormonal fluctuations, hemiplegic migraine associated with hormonal fluctuations, ophthalmoplegic migraine associated with hormonal fluctuations, and retinal migraine associated with hormonal fluctuations. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


In this article, the author reviews the complex relations between headache and ovarian sex hormones in women. The author discusses the changes in headache patterns during the major hormonal events (menarche, pregnancy, menopause) in the woman's life cycle and the effects of hormonal contraception and hormone replacement therapy on headache. Advances in elucidating the association between hormonal milieu and headache and new data on the possible mechanisms through which estrogen affects migraine and pain perception are presented. Therapeutic approaches and evidence-based practice regarding the management of menstrual migraine, migraine during pregnancy, and migraine in the perimenopausal and postmenopausal periods are analyzed. The potential complications and benefits of the use of hormonal contraceptives and hormone replacement therapy in women with migraine are also discussed based on evidence from clinical studies.

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