CONy 2021 | Is estrogen safe and effective for menstruation-related migraine?

Oved Daniel, MD, Ramat Aviv Medical Center, Tel-Aviv, Israel, gives an overview of a debate on whether estrogen is a safe and effective therapy for menstruation-related migraine. The pro side of the discussion supports that patients experiencing migraine without aura can safely use estrogen-containing contraceptives as a strategy to avoid the estrogen drop probably related to the menstrual-related migraine attacks. While individuals with migraine with aura are generally not candidates for estrogen therapy due to an increased relative risk of stroke. On the other hand, there is no correlation between estrogen levels and menstruation-related migraine. Evidence from randomized clinical trials for menstruation-related migraine prevention with estrogen is weak, while prevention with triptans is much stronger. Moreover, a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC) reports that the quality of evidence for the treatment of migraine during reproductive age with estrogen is low, and the strength of recommendations is weak. This interview was conducted during the virtual 2021 World Congress on Controversies in Neurology (CONy) meeting.