How can taking estrogen treat my menstrual migraines?

Blunting the significant drop in estrogen just before menses sometimes can help reduce menstrual migraine. An estrogen patch, pill, or gel can effectively decrease the steep decline in estrogen and minimize headache symptoms. In general, transdermal estrogen in a patch or gel form is the most effective for menstrual migraine, because it provides the steadiest concentration of estrogen.

Estrogen should generally be started up to 5 days before you expect your period in order to effectively blunt the usual drop in estrogen. Some women use estrogen-containing oral contraceptive pills (birth control pills) to help reduce menstrual symptoms, including menstrual migraine. Traditional oral contraceptives include 3 weeks of active pills containing hormones and a 4th week of placebo or sugar pills that don't.

(The reason for taking the placebo pills is to keep you in the habit of taking your birth control pill every day.) Estrogen levels drop during the placebo week, and you will have menstrual bleeding that is just like a normal period. In some cases, your doctor may suggest that you skip the placebo week of your birth control pill -- starting the next pill pack after you finish the 3 active pill weeks. You may take only active pills for 2 or 3months before returning to using the placebo week and having a period.

Taking a monophasic pill (those with the same dose of estrogen in all tablets) in the lowest possible estrogen dose -- typically 20 mcg -- continuously without placebo pills is often the best way to prevent menstrual headaches with hormonal therapy.

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