[Treatment of menstrual cycle associated migraine]

A high percentage of migraine in women is closely related to the menstrual cycle either at the time of ovulation or in the perimenstrual period. It can be assumed that rapid serum fluctuations due to the decline of serum estrogens and or progesterone trigger this type of headache. With respect to a possible endocrine mechanism a hormonal treatment seems to be useful in order to avoid migraine or at least to decrease the complaints. Periovulatory migraine can be easily treated with oral contraceptives (o.c.). In women already taking o.c. with headaches in the perimenstrual period either low dose progestogens (minipill) or 0.5 mg estriol up to three times per day during the whole interval can be tried. In women not taking o.c. a corresponding therapy from day 20 of the cycle is indicated. It is important to choose the dosage to be neutral towards bleeding behavior.