Estrogen replacement and migraine

Four of every 10 women will experience migraine at some time in their lives, with peak prevalence in middle life. Evidence supports estrogen ‘withdrawal’ as one of the important triggers of menstrual attacks of migraine without aura. Improvement of migraine without aura postmenopause is generally attributed to the absence of variations in sex hormone levels. Maintaining a stable estrogen environment is best achieved using non-oral estrogen replacement. Unlike migraine without aura, migraine with aura is recognized as a marker for increased risk of ischemic stroke. Research suggests that aura may be more likely to affect women with underlying coagulation disorders. This could, at least in part, account for both increased risk of stroke and the dose related effect of estrogen replacement on the development of aura. Hence women with migraine with aura requiring estrogen replacement should be given the lowest effective dose necessary to control menopause symptoms, by a non-oral route.