Ovarian Hormones and Migraine Headache: Understanding Mechanisms and Pathogenesis--Part 2

Vincent T. Martin, MD; Michael Behbehani, PhD


Headache. 2006;46(3):365-386. 

In This Article

Abstract and Introduction

Migraine headache is strongly influenced by reproductive events that occur throughout the lifespan of women. Each of these reproductive events has a different "hormonal milieu," which might modulate the clinical course of migraine headache. Estrogen and progesterone can be preventative or provocative for migraine headache under different circumstances depending on their absolute serum levels, constancy of exposure, and types of estrogen/progesterone derivatives. Attacks of migraine with and without aura respond differently to changes in ovarian hormones. Clearly a greater knowledge of ovarian hormones and their effect on migraine is essential to a greater understanding of the mechanisms and pathogenesis of migraine headache.

During part 1 of this series, we reviewed the genomic and nongenomic effects of ovarian hormones on the central nervous system as well as the current basic science studies linking them to the pathogenesis of migraine headache. These studies clearly indicate that ovarian hormones can alter neurotransmitter systems theorized to play an important role in the pathogenesis of migraine headache. Numerous clinical studies also exist to provide clues to how ovarian hormones might modulate migraine headaches. Migraine headaches are likely influenced by the different "hormonal milieus" encountered during reproductive life events that begin during menarche and continue through menopause. The purpose of this manuscript will be to review existing clinical studies examining the course of migraine headache during reproductive life events (eg, menarche, menstrual cycles, pregnancy, lactation, and menopause) as well as after administration of exogenous hormones (eg, oral contraceptives [OCPs] and hormone replacement therapy [HRT]). We will also define the specific serum levels of ovarian hormones encountered during the different reproductive life events and postulate mechanisms through which they might affect migraine headache.


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