Feature Article

Episodic migraine in women

Elspeth Hutton, Richard Stark



Hormonal changes experienced by women at various stages of life can affect the frequency and duration of migraine. Treating pregnant or breastfeeding women with migraine can pose a challenge for GPs.

Key Points

  • There are significant associations between migraine activity and hormonal fluctuations throughout a woman’s life.
  • Migraine with aura increases the risk of stroke from a very low baseline. Smoking and use of oral contraceptives both increase the risk further. In any individual, the risks must be balanced against the benefits of taking the oral contraceptive pill.
  • Treatment options for menstrual migraine include standard acute and prophylactic treatments, hormonal manipulation and short-term prophylactic regimens at the vulnerable time (‘mini-prophylaxis’).
  • Migraine may worsen or improve in the first trimester, but generally improves significantly for the remainder of the pregnancy.
  • Management of migraine during pregnancy is difficult because of warnings about the use of many relevant drugs during pregnancy and lactation.