Estrogen ‘withdrawal’ – the fall in estrogen levels around the time of menstruation and during the pill-free week of the combined contraceptive ‘Pill’ – is a recognised trigger for menstrual migraine.
However, new research suggests that other mechanisms are just as important. A colleague in Norway asked women about how their method of contraception affected their migraine. She found that women using the levonorgestrel intrauterine system reported a significant improvement in migraine. This method allows the normal hormone cycle to continue as usual, including the cyclical fluctuations in estrogen, but without any menstrual bleeding. While we need to do more research to identify the exact mechanism, these preliminary findings suggest that processes associated with the menstrual bleed are also important in triggering migraine.
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