Estrogen-withdrawal migraine. II. Attempted prophylaxis by continuous estradiol administration

Prophylaxis of menstrual migraine was attempted in five women, using estradiol implants. The treatment was successful in suppressing ovulation and in producing high, although fluctuating, levels of estradiol in the plasma. Clinically this was associated with severe menstrual disturbance. The regular periodicity of the headaches was lost, but clinical benefit was unpredictable, with some patients actually experiencing more headaches than before the treatment. The administration of progesterone against a background of prolonged exposure to high estrogen levels did not provoke migraine, nor in any case did its subsequent withdrawal result in migraine. These findings cast further doubt on the importance of progesterone withdrawal in the etiology of menstrual migraine.