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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
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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.
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