title: Migraine and estrogen.
abstract: OBJECTIVE
  The aim is to systematically and critically review the relationship between migraine and estrogen, the predominant female sex hormone, with a focus on studies published in the last 18 months.
  
  
  RESULTS
  Recent functional MRI (fMRI) studies of the brain support the existence of anatomical and functional differences between men and women, as well as between participants with migraine and healthy controls. In addition to the naturally occurring changes in endogenous sex hormones over the lifespan (e.g. puberty and menopause), exogenous sex hormones (e.g. hormonal contraception or hormone therapy) also may modulate migraine. Recent data support the historical view of an elevated risk of migraine with significant drops in estrogen levels. In addition, several lines of research support that reducing the magnitude of decline in estrogen concentrations prevents menstrually related migraine (MRM) and migraine aura frequency.
  
  
  CONCLUSIONS
  Current literature has consistently demonstrated that headache, in particular migraine, is more prevalent in women as compared with men, specifically during reproductive years. Recent studies have found differences in headache characteristics, central nervous system anatomy, as well as functional activation by fMRI between the sexes in migraine patients. Although the cause underlying these differences is likely multifactorial, considerable evidence supports an important role for sex hormones. Recent studies continue to support that MRM is precipitated by drops in estrogen concentrations, and minimizing this decline may prevent these headaches. Limited data also suggest that specific regimens of combined hormone contraceptive use in MRM and migraine with aura may decrease both headache frequency and aura.
authors.affiliation: aDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland bCarolina Headache Institute, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Nu Cindy
authors.initials: NC
authors.lastname: Chai
authors.forename: B Lee
authors.initials: BL
authors.lastname: Peterlin
authors.forename: Anne H
authors.initials: AH
authors.lastname: Calhoun
mesh_terms: D001921:Brain / Q000378:metabolism / Q000473:pathology*; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D004967:Estrogens / Q000378:metabolism* / Q000627:therapeutic use; D005260:Female; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008593:Menopause / Q000378:metabolism*; D008881:Migraine Disorders / Q000378:metabolism* / Q000473:pathology; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens