Focus on primary care diagnosis and management of headache in women

Women experience unique changes in headache pattern related to changes in their reproductive cycles. Changes predictably occur in association with menarche, menstrual cycling, the use of oral contraceptives, pregnancy, and menopause. These predictable headache changes are linked to changing levels of sex hormones. This article describes important relationships between estradiol and neurotransmitters involved in the pathogenesis of headache, such as serotonin. Treatment of headache in women includes the use of acute care and preventive treatments. The effectiveness of both medication and nonmedication treatments is reviewed. Also, unique aspects of treating headache with menstruation, pregnancy, and menopause are described.