Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence

Menstrual migraine affects approximately 6% of women of reproductive age and is characterized by migraine attacks closely linked to the menstrual cycle. The prevailing theory, known as the estrogen withdrawal hypothesis, suggests that the drop in estrogen levels before menstruation triggers these attacks. However, the evidence supporting this hypothesis is limited and requires further research, focusing on the interplay between estrogen, the trigeminovascular system, and migraine.

• 1
  Existing studies on the estrogen withdrawal hypothesis are limited by methodological inconsistencies, small sample sizes, and variable case definitions.
• 2
  Perimenstrual migraine attacks are often more disabling, persist longer, and may exhibit a higher recurrence rate after triptan treatment compared to non-menstrual attacks.
• 3
  Human experimental studies on estrogen-dependent pain sensitivity are inconclusive, but some evidence suggests that estrogen withdrawal may facilitate pro-nociceptive responses.