Hormonal interventions for menstrual migraines.

Menstrual migraines are a treatment challenge for both the migraineur and the health care professional. Although some women with menstrual migraines may respond to acute and preventive therapies for nonmenstrual migraines, others continue to suffer from refractory menstrual migraines. These women may respond to hormonal interventions, which may reduce the frequency of menstrual migraines, thereby lessening the need for abortive migraine therapies, decreasing migraine-related disability, and improving quality of life. Menstrual migraines have a distinct pathophysiology that differs from menstrual-related migraines. Published studies have shed light on the effectiveness of a variety of hormonal interventions, including oral contraceptives, which may be administered with an extended-dosing strategy; estrogen replacement therapy; selective estrogen receptor modifiers; danazol; and leuprolide.