Published Online
on September 30, 2004

A more recent version of this article appeared on November 1, 2004

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Submitted on June 15, 2004
Accepted on August 5, 2004

Estrogens, Migraine, and Stroke

Marie-Germaine Bousser MD^*

From the Department of Neurology, Lariboisière Hospital, Paris, France.

^* To whom correspondence should be addressed. E-mail: mg.bousser{at}lrb.ap-hop-paris.fr.

Abstract--Epidemiological studies suggest the existence of close but complex relationships between estrogens, migraine, and stroke in women before menopause. Migraine, particularly without aura, is strongly influenced by estrogens as illustrated by the frequency of onset at puberty, of menstrual migraine, and of improvement during pregnancy. Migraine, particularly with aura, is a risk factor for ischemic stroke with a relative risk of 3, further increased by tobacco smoking and oral contraceptive use. The pathophysiological mechanism underlying these close relationships remains unknown. In practice, given the very low absolute risk of stroke in young women, there is no systematic contraindication to oral contraceptive use in young female migraineurs but rather a firm recommendation for no smoking and for the use of low-estrogen-content pills or progestogens only, particularly in migraine with aura.

Key words: contraceptives, oral • estrogens • hormone replacement therapy • migraine • stroke

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