Hormonal Contraception and HRT for Migraine

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Key Questions
  • How many women have hormonal migraine?
  • What is the relationship between hormonal migraine and other types of migraine?
  • Why is hormonal migraine often missed?
  • What are three different types of diagnoses related to hormone and migraine?
  • How important is the exact diagnosis for treatment?
  • Is it possible to effectively manage menstrual migraine?
  • Is there a standard treatment for menstrual migraine or should it be customized to each individual?
  • Who is the best person to see for a hormonally-related migraine condition?
  • Why is record-keeping so important to treatment when a woman suspects hormonal migraine?
  • Which hormones are involved in hormonal migraine and how does their involvement impact treatment?
  • How can NSAIDs be used in symptomatic treatment and prevention of menstrual migraine?
  • What role can contraceptives play in treatment of hormonal migraine?
  • What is a common strategy some doctors will use for hormonal migraine?
  • Are hormone level measurements helpful in treating menstrual migraine?
  • Why do hormones cause a migraine in some women and not others?
  • Is there anything wrong with the hormone levels of women with hormonal migraine?
  • What is the connection between migraine and other conditions such as endometriosis, polycystic ovary syndrome, or hypothyroidism?
  • How does someone’s general health affect their migraine condition?
  • What are the safety considerations related to stopping periods as a treatment for menstrual migraine?
  • What is the optimal contraceptive method/option for someone with hormonal migraine?
  • What is the difference between pre-menstrual prevention and regular migraine prevention?
  • What type of migraines are more severe, refractory to treatment and longer lasting than others?
  • What options do women with migraine with aura have for treatment?
  • Can women with migraine with aura safely take the contraceptive pill?
  • Are there natural alternatives that can be used to treat hormonal migraine?
  • What other advice would you give to your patients?
Interview Notes

Find more about Anne MacGregor, MD and her work here:

Anne MacGregor, MD

Centre for Reproductive Medicine, St Bartholomew’s Hospital, London, UK

Dr. Anne MacGregor is a world leader in studying the link between the menstrual cycle and migraine. She holds a doctorate in medicine from the University of London and a master’s in medical education from the Royal College of Physicians and University College London. Dr. MacGregor is an honorary professor at the Blizard Centre for Neuroscience, Surgery and Trauma; the Blizard Institute of Cell and Molecular Science; and Barts and The London School of Medicine and Dentistry. She has published more than 200 research papers, authored five books, co-authored an additional five books, and co-edited three books.

Dr. MacGregor has carried out extensive research into drug treatments for migraine and cluster headache, including significant research into menstrual migraine. Her doctoral thesis explored the role of estrogen in migraine, which led to the development of research criteria for menstrual migraine that were adopted by the International Headache Society in 2004. She has been awarded the Elizabeth Garrett Anderson Award for her extraordinary contribution to relieving those affected by the burden of headache and has received the Special Recognition Award and Honorary Life Membership from the International Headache Society. Dr. MacGregor regularly contributes to media discussions on the topic of migraine, particularly menstrual migraine.

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