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Menstrual cycle and migraine frequency

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In this figure, serum levels of hormones and their effect on the endometrium over the course of the menstrual cycle are depicted, as well as the concurrence of fluctuations in the incidence of migraine attacks in women with menstrual migraine. Lasting around 28 days, the cycle starts with the release of follicle stimulating hormone, stimulating the growth of ovarian follicles. The maturation of these follicles leads to an increasing production of estradiol, which triggers a surge in luteinizing hormone and causes ovulation. After ovulation, the ruptured follicle transforms into the corpus luteum, which produces progesterone and prepares the endometrium for possible fertilization. If fertilization does not occur, the corpus luteum breaks down progesterone and estradiol levels drop, which triggers menstruation and the start of a new menstrual cycle. The decline of estradiol ("estradiol-withdrawal") is thought to precipitate migraine without aura in women with menstrual migraine.

Sources:
Reddy N, Desai MN, Schoenbrunner A, Schneeberger S, Janis JE. The complex relationship between estrogen and migraines: a scoping review. Syst Rev 2021a;10[1]:72.
van Lohuizen R, Paungarttner J, Lampl C, MaassenVanDenBrink A, Al-Hassany L. Considerations for hormonal therapy in migraine patients: a critical review of current practice. Expert Rev Neurother 2023;24[1]:1-21.
Martin VT, Lipton RB. Epidemiology and biology of menstrual migraine. Headache 2008;48 Suppl 3:S124-30.
MacGregor EA, Okonkwo R, Detke HC, Polavieja P, Fernandes MS, Pavlovic JM. Effect of galcanezumab in women with episodic migraine meeting criteria for menstrually related migraine: a post hoc analysis of EVOLVE-1 and EVOLVE-2. Headache 2024;64[2]:179-87.

(Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)