Headache Drugs Logo
Home | About Dr. Robbins | Archived Articles | Headache Books | Topic Index  

Back to List



A Novel Specific Prophylaxis for the Estrogen
Withdrawal Migraine
A.H. Calhoun
Posted August 2003
Presented at: 45th Annual Scientific Meeting
American Headache Society

June 19-22, 2003; Chicago, Illinois

Objectives: A small pilot study to test the efficacy of a novel, specific, and inexpensive prophylactic strategy for arguably the most common migraine trigger: estrogen withdrawal.

Conclusions: The physiologic fall in estradiol associated with the menstrual migraine is equivalent to 20-25 mg. ethinyl estradiol. As all currently available estrogen-containing oral contraceptives produce a menstrual fall in estradiol of at least 20 mg., none would be expected to improve menstrual migraine. The majority of oral contraceptives in use in the US contain 30-35 mg. ethinyl estradiol which would be expected to intensify the associated migraine. Estrogen supplementation during the placebo week can reduce the magnitude of this fall. When the decline is limited to the equivalent of 10 mg. ethinyl estradiol, the estrogen withdrawal migraine is prevented. At an average cost of six dollars per headache day prevented, this represents an effective and inexpensive strategy for one of the most common migraine triggers.