Abstract
Headache is a neurologic disorder that displays gender dichotomy. It is well established
that there is a strong link between migraine headache and sex hormones, specifically
estrogen, which influences the severity of migraines during the menstrual cycle, pregnancy,
and menopause. Furthermore, the epidemiology of headaches during pregnancy and the
postpartum period is very distinct from that in males or nonpregnant females, in part
due to the hemodynamic and hematologic changes that occur during pregnancy. These
changes put women at higher risk for cerebral venous thrombosis, hemorrhagic stroke,
and hypertensive disorders of pregnancy like preeclampsia, eclampsia, posterior reversible
encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome. Headache
in pregnancy and the puerperium can be a cause of heightened anxiety in most women,
who are concerned not only about the effect of the headache itself on the pregnancy
but also about the effect of the treatment options on the pregnancy and the fetus.
In this review, we discuss the latest literature on type and distribution of headaches
during pregnancy and the postpartum period, and provide a digestible overview of the
safety profile of commonly used abortive and prophylactic medications. We also discuss
important considerations when treating migraine during menopause.
Keywords
headache - migraine - estrogen - pregnancy - menopause
