Semin Neurol 2017; 37(06): 601-610
DOI: 10.1055/s-0037-1607393
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Migraine in Women

Susan W. Broner
1   Department of Neurology, Weill Cornell Medical College, New York, New York
,
Sarah Bobker
1   Department of Neurology, Weill Cornell Medical College, New York, New York
,
Louise Klebanoff
1   Department of Neurology, Weill Cornell Medical College, New York, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2017 (online)

Abstract

Migraine is one of the most common neurological disorders, affecting women disproportionally at a rate of 3:1. Prior to puberty, boys and girls are equally affected, but the female preponderance emerges after puberty. Migraine pathophysiology is not fully understood, and although the hormonal effect of estrogen is significant, other factors are at play. This article will focus on the hormonal influence on migraine in women. Here we review our most recent understanding of migraine and menstrual migraine, including epidemiology, pathophysiology, and treatment strategies for this challenging disorder, as well as migraine during pregnancy, postpartum period, breastfeeding, perimenopause, and menopause. We also review the risks and benefits of exogenous hormone use in this population and discuss stroke risk in women with migraine aura. By understanding these aspects of migraine in women, we hope to arm practitioners with the knowledge and tools to help guide treatment of this debilitating disorder in this large population.

 
  • References

  • 1 Stone J, Carson A, Duncan R. , et al. Who is referred to neurology clinics?--the diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010; 112 (09) 747-751
  • 2 World Health Organization. Atlas of Headache Disorders and Resources in the World 2011. Geneva, Switzerland: World Health Organization; 2011
  • 3 Pavlovic JM, Akcali D, Bolay H, Bernstein C, Maleki N. Sex-related influences in migraine. J Neurosci Res 2017; 95 (1–2): 587-593
  • 4 Merikangas KR. Contributions of epidemiology to our understanding of migraine. Headache 2013; 53 (02) 230-246
  • 5 Linet MS, Stewart WF. Migraine headache: epidemiologic perspectives. Epidemiol Rev 1984; 6: 107-139
  • 6 Lipton RB, Bigal ME, Diamond M, Freitag DO, Reed ML, Stewart WF. ; AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007; 68 (05) 343-349
  • 7 Stewart WF, Wood C, Reed ML, Roy J, Lipton RB. ; AMPP Advisory Group. Cumulative lifetime migraine incidence in women and men. Cephalalgia 2008; 28 (11) 1170-8
  • 8 Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (09) 629-880
  • 9 Epstein MT, Hockaday JM, Hockaday TD. Migraine and reporoductive hormones throughout the menstrual cycle. Lancet 1975; 1 (7906): 543-548
  • 10 Pavlović JM, Stewart WF, Bruce CA. , et al. Burden of migraine related to menses: results from the AMPP study. J Headache Pain 2015; 16: 24
  • 11 MacGregor EA, Victor TW, Hu X. , et al. Characteristics of menstrual vs nonmenstrual migraine: a post hoc, within-woman analysis of the usual-care phase of a nonrandomized menstrual migraine clinical trial. Headache 2010; 50 (04) 528-538
  • 12 Boardman HF, Thomas E, Croft PR, Millson DS. Epidemiology of headache in an English district. Cephalalgia 2003; 23 (02) 129-137
  • 13 Celentano DD, Linet MS, Stewart WF. Gender differences in the experience of headache. Soc Sci Med 1990; 30 (12) 1289-1295
  • 14 Macgregor EA, Rosenberg JD, Kurth T. Sex-related differences in epidemiological and clinic-based headache studies. Headache 2011; 51 (06) 843-859
  • 15 Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013:a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386 (9995): 743-800
  • 16 Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P. Headache disorders are third cause of disability worldwide. J Headache Pain 2015; 16: 58
  • 17 Steiner TJ, Stovner LJ, Vos T. GBD 2015: migraine is the third cause of disability in under 50s. J Headache Pain 2016; 17 (01) 104
  • 18 Merikangas KR, Cui L, Richardson AK. , et al. Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study. BMJ 2011; 343: d5076
  • 19 Wolff HG. Headache and Other Head Pain. 2nd ed. New York, NY: Oxford University Press; 1963
  • 20 Pietrobon D, Moskowitz MA. Pathophysiology of migraine. Annu Rev Physiol 2013; 75: 365-391
  • 21 Goadsby PJ. Pathophysiology of migraine. Neurol Clin 2009; 27 (02) 335-360
  • 22 Puledda F, Messina R, Goadsby PJ. An update on migraine: current understanding and future directions. J Neurol 2017; 264 (09) 2031-2039
  • 23 Parantainen J, Vapaatalo H, Hokkanen E. Relevance of prostaglandins in migraine. Cephalalgia 1985; 5 (Suppl. 02) 93-97
  • 24 Somerville BW. Estrogen-withdrawal migraine II. Attempted prophylaxis by continuous estradiol administration. Neurology 1975; 25 (03) 245
  • 25 Karkhaneh A, Ansari M, Emamgholipour S, Rafiee MH. The effect of 17β-estradiol on gene expression of calcitonin gene-related peptide and some pro-inflammatory mediators in peripheral blood mononuclear cells from patients with pure menstrual migraine. Iran J Basic Med Sci 2015; 18 (09) 894-901
  • 26 Pavlović JM, Allshouse AA, Santoro NF. , et al. Sex hormones in women with and without migraine: Evidence of migraine-specific hormone profiles. Neurology 2016; 87 (01) 49-56
  • 27 Sutherland HG, Champion M, Plays A. , et al. Investigation of polymorphisms in genes involved in estrogen metabolism in menstrual migraine. Gene 2017; 607: 36-40
  • 28 Colson N, Fernandez F, Griffiths L. Genetics of menstrual migraine: the molecular evidence. Curr Pain Headache Rep 2010; 14 (05) 389-395
  • 29 Rodriguez-Acevedo AJ, Smith RA, Roy B. , et al. Genetic association and gene expression studies suggest that genetic variants in the SYNE1 and TNF genes are related to menstrual migraine. J Headache Pain 2014; 15: 62
  • 30 Nattero G, Allais G, De Lorenzo C. , et al. Relevance of prostaglandins in true menstrual migraine. Headache 1989; 29 (04) 233-238
  • 31 Silberstein SD, Merriam GR. Sex hormones and headache. J Pain Symptom Manage 1993; 8 (02) 98-114
  • 32 Benedetto C, Allais G, Ciochetto D, De Lorenzo C. Pathophysiological aspects of menstrual migraine. Cephalalgia 1997; 17 (Suppl. 20) 32-34
  • 33 Allais G, Facco G, Ciochetto D, De Lorenzo C, Fiore M, Benedetto C. Patterns of platelet aggregation in menstrual migraine. Cephalalgia 1997; 17 (Suppl. 20) 39-41
  • 34 Varlibas A, Erdemoglu AK. Altered trigeminal system excitability in menstrual migraine patients. J Headache Pain 2009; 10 (04) 277-282
  • 35 de Tommaso M, Valeriani M, Sardaro M. , et al. Pain perception and laser evoked potentials during menstrual cycle in migraine. J Headache Pain 2009; 10 (06) 423-429
  • 36 Saleeon W, Jansri U, Srikiatkhachorn A, Bongsebandhu-phubhakdi S. Estrous cycle induces peripheral sensitization in trigeminal ganglion neurons: an animal model of menstrual migraine. J Med Assoc Thai 2016; 99 (02) 206-212
  • 37 Chauvel V, Schoenen J, Multon S. Influence of ovarian hormones on cortical spreading depression and its suppression by L-kynurenine in rat. PLoS One 2013; 8 (12) e82279
  • 38 Ferrari MD, Klever RR, Terwindt GM, Ayata C, van den Maagdenberg AM. Migraine pathophysiology: lessons from mouse models and human genetics. Lancet Neurol 2015; 14 (01) 65-80
  • 39 Chauvel V, Multon S, Schoenen J. Estrogen-dependent effects of 5-hydroxytryptophan on cortical spreading depression in rat: Modelling the serotonin-ovarian hormone interaction in migraine aura. Cephalalgia 2017; (Epub ahead of print) DOI: 10.1177/0333102417690891.
  • 40 Asghari R, Lung MS, Pilowsky PM, Connor M. Sex differences in the expression of serotonin-synthesizing enzymes in mouse trigeminal ganglia. Neuroscience 2011; 199: 429-437
  • 41 MacGregor EA. A review of frovatriptan for the treatment of menstrual migraine. Int J Womens Health 2014; 6: 523-535
  • 42 Bussone G, Allais G, Castagnoli Gabellari I, Benedetto C. Almotriptan for menstrually related migraine. Expert Opin Pharmacother 2011; 12 (12) 1933-1943
  • 43 Allais G, Bussone G, D'Andrea G. , et al. Almotriptan 12.5 mg in menstrually related migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 2011; 31 (02) 144-151
  • 44 Massiou H, Jamin C, Hinzelin G, Bidaut-Mazel C. ; French Naramig Collaborative Study Group. Efficacy of oral naratriptan in the treatment of menstrually related migraine. Eur J Neurol 2005; 12 (10) 774-781
  • 45 Solbach MP, Waymer RS. Treatment of menstruation-associated migraine headache with subcutaneous sumatriptan. Obstet Gynecol 1993; 82 (05) 769-772
  • 46 Schreiber CP, Cady RK. Diagnosis of menstrual headache and an open-label study among those with previously undiagnosed menstrually related migraine to evaluate the efficacy of sumatriptan 100 mg. Clin Ther 2007; 29 (Suppl): 2511-2519
  • 47 Landy S, Savani N, Shackelford S, Loftus J, Jones M. Efficacy and tolerability of sumatriptan tablets administered during the mild-pain phase of menstrually associated migraine. Int J Clin Pract 2004; 58 (10) 913-919
  • 48 Nett R, Landy S, Shackelford S, Richardson MS, Ames M, Lener M. Pain-free efficacy after treatment with sumatriptan in the mild pain phase of menstrually associated migraine. Obstet Gynecol 2003; 102 (04) 835-842
  • 49 Silberstein SD, Massiou H, Le Jeunne C, Johnson-Pratt L, McCarroll KA, Lines CR. Rizatriptan in the treatment of menstrual migraine. Obstet Gynecol 2000; 96 (02) 237-242
  • 50 Mannix LK, Loder E, Nett R. , et al. Rizatriptan for the acute treatment of ICHD-II proposed menstrual migraine: two prospective, randomized, placebo-controlled, double-blind studies. Cephalalgia 2007; 27 (05) 414-421
  • 51 Tuchman M, Hee A, Emeribe U, Silberstein S. Efficacy and tolerability of zolmitriptan oral tablet in the acute treatment of menstrual migraine. CNS Drugs 2006; 20 (12) 1019-1026
  • 52 Loder E, Silberstein SD, Abu-Shakra S, Mueller L, Smith T. Efficacy and tolerability of oral zolmitriptan in menstrually associated migraine: a randomized, prospective, parallel-group, double-blind, placebo-controlled study. Headache 2004; 44 (02) 120-130
  • 53 Allais G, Tullo V, Omboni S. , et al. Frovatriptan vs. other triptans for the acute treatment of oral contraceptive-induced menstrual migraine: pooled analysis of three double-blind, randomized, crossover, multicenter studies. Neurol Sci 2013; 34 (Suppl. 01) S83-S86
  • 54 Bartolini M, Giamberardino MA, Lisotto C. , et al. Frovatriptan versus almotriptan for acute treatment of menstrual migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study. J Headache Pain 2012; 13 (05) 401-406
  • 55 Allais G, Bussone G, Tullo V. , et al. Frovatriptan 2.5 mg plus dexketoprofen (25 mg or 37.5 mg) in menstrually related migraine. Subanalysis from a double-blind, randomized trial. Cephalalgia 2015; 35 (01) 45-50
  • 56 Cady RK, Diamond ML, Diamond MP. , et al. Sumatriptan-naproxen sodium for menstrual migraine and dysmenorrhea: satisfaction, productivity, and functional disability outcomes. Headache 2011; 51 (05) 664-673
  • 57 Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E. ; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012; 78 (17) 1337-1345
  • 58 Silberstein SD, Elkind AH, Schreiber C, Keywood C. A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurology 2004; 63 (02) 261-269
  • 59 Tuchman MM, Hee A, Emeribe U, Silberstein S. Oral zolmitriptan in the short-term prevention of menstrual migraine: a randomized, placebo-controlled study. CNS Drugs 2008; 22 (10) 877-886
  • 60 Newman L, Mannix LK, Landy S. , et al. Naratriptan as short-term prophylaxis of menstrually associated migraine: a randomized, double-blind, placebo-controlled study. Headache 2001; 41 (03) 248-256
  • 61 Marcus DA, Bernstein CD, Sullivan EA, Rudy TE. Perimenstrual eletriptan prevents menstrual migraine: an open-label study. Headache 2010; 50 (04) 551-562
  • 62 Bhambri R, Martin VT, Abdulsattar Y. , et al. Comparing the efficacy of eletriptan for migraine in women during menstrual and non-menstrual time periods: a pooled analysis of randomized controlled trials. Headache 2014; 54 (02) 343-354
  • 63 Newman LC, Lipton RB, Lay CL, Solomon S. A pilot study of oral sumatriptan as intermittent prophylaxis of menstruation-related migraine. Neurology 1998; 51 (01) 307-309
  • 64 MacGregor EA, Brandes JL, Silberstein S. , et al. Safety and tolerability of short-term preventive frovatriptan: a combined analysis. Headache 2009; 49 (09) 1298-1314
  • 65 Al-Waili NS. Treatment of menstrual migraine with prostaglandin synthesis inhibitor mefenamic acid: double-blind study with placebo. Eur J Med Res 2000; 5 (04) 176-182
  • 66 Sances G, Martignoni E, Fioroni L, Blandini F, Facchinetti F, Nappi G. Naproxen sodium in menstrual migraine prophylaxis: a double-blind placebo controlled study. Headache 1990; 30 (11) 705-709
  • 67 Edelson RN. Menstrual migraine and other hormonal aspects of migraine. Headache 1985; 25 (07) 376-379
  • 68 D'Alessandro R, Gamberini G, Lozito A, Sacquegna T. Menstrual migraine: intermittent prophylaxis with a timed-release pharmacological formulation of dihydroergotamine. Cephalalgia 1983; 3 (Suppl. 01) 156-158
  • 69 Silberstein S, Bradley K. DHE-45® in the prophylaxis of menstrually related migraine. Platform presentation at the IX Migraine Trust International Symposium, London, UK, September 1996. Cephalalgia 1996; 16: 371
  • 70 Silberstein SD, Frietag FG, Bigal ME. Migraine treatment. In: Stephen D. Silberstein, Richard B. Lipton, and David W. Dodick, eds. Wolff's Headache and Other Head Pain, 8th ed. New York, NY: Oxford University Press; 2008: 177-192
  • 71 Dennerstein L, Morse C, Burrows G, Oats J, Brown J, Smith M. Menstrual migraine: a double-blind trial of percutaneous estradiol. Gynecol Endocrinol 1988; 2 (02) 113-120
  • 72 de Lignières B, Vincens M, Mauvais-Jarvis P, Mas JL, Touboul PJ, Bousser MG. Prevention of menstrual migraine by percutaneous oestradiol. Br Med J (Clin Res Ed) 1986; 293 (6561): 1540
  • 73 Calhoun A, Ford S. Elimination of menstrual-related migraine beneficially impacts chronification and medication overuse. Headache 2008; 48 (08) 1186-1193
  • 74 Sulak P, Willis S, Kuehl T, Coffee A, Clark J. Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 2007; 47 (01) 27-37
  • 75 Calhoun A, Ford S, Pruitt A. The impact of extended-cycle vaginal ring contraception on migraine aura: a retrospective case series. Headache 2012; 52 (08) 1246-1253
  • 76 Morotti M, Remorgida V, Venturini PL, Ferrero S. Progestogen-only contraceptive pill compared with combined oral contraceptive in the treatment of pain symptoms caused by endometriosis in patients with migraine without aura. Eur J Obstet Gynecol Reprod Biol 2014; 179: 63-68
  • 77 Warhurst S, Rofe CJ, Brew BJ. , et al. Effectiveness of the progestin-only pill for migraine treatment in women: a systematic review and meta-analysis. Cephalalgia 2017; (Epub ahead of print]) DOI: 10.1177/0333102417710636.
  • 78 Neri I, Granella F, Nappi R, Manzoni GC, Facchinetti F, Genazzani AR. Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas 1993; 17 (01) 31-37
  • 79 Ziaei S, Kazemnejad A, Sedighi A. The effect of vitamin E on the treatment of menstrual migraine. Med Sci Monit 2009; 15 (01) CR16-CR19
  • 80 Kashanian M, Lakeh MM, Ghasemi A, Noori S. Evaluation of the effect of vitamin E on pelvic pain reduction in women suffering from primary dysmenorrhea. J Reprod Med 2013; 58 (1–2): 34-38
  • 81 Facchinetti F, Sances G, Borella P, Genazzani AR, Nappi G. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991; 31 (05) 298-301
  • 82 Zhang XZ, Zhang L, Guo J. , et al. Acupuncture as prophylaxis for menstrual-related migraine: study protocol for a multicenter randomized controlled trial. Trials 2013; 14: 374
  • 83 Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84 (05) 478-485
  • 84 Fox AW, Davis RL. Migraine chronobiology. Headache 1998; 38 (06) 436-441
  • 85 Aubé M. Migraine in pregnancy. Neurology 1999; 53 (04) (Suppl. 01) S26-S28
  • 86 Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr 2014; 168 (04) 313-320
  • 87 Brandlistuen RE, Ystrom E, Nulman I, Koren G, Nordeng H. Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study. Int J Epidemiol 2013; 42 (06) 1702-1713
  • 88 Avella-Garcia CB, Julvez J, Fortuny J. , et al. Acetaminophen use in pregnancy and neurodevelopment: attention function and autism spectrum symptoms. Int J Epidemiol 2016; 45 (06) 1987-1996
  • 89 Babb M, Koren G, Einarson A. Treating pain during pregnancy. Can Fam Physician 2010; 56 (01) 25-27
  • 90 Danielsson B, Wikner BN, Källén B. Use of ondansetron during pregnancy and congenital malformations in the infant. Reprod Toxicol 2014; 50: 134-137
  • 91 Wood ME, Frazier JA, Nordeng HM, Lapane KL. Prenatal triptan exposure and parent-reported early childhood neurodevelopmental outcomes: an application of propensity score calibration to adjust for unmeasured confounding by migraine severity. Pharmacoepidemiol Drug Saf 2016; 25 (05) 493-502
  • 92 Marchenko A, Etwel F, Olutunfese O, Nickel C, Koren G, Nulman I. Pregnancy outcome following prenatal exposure to triptan medications: a meta-analysis. Headache 2015; 55 (04) 490-501
  • 93 Chen HM, Chen SF, Chen YH, Lin HC. Increased risk of adverse pregnancy outcomes for women with migraines: a nationwide population-based study. Cephalalgia 2010; 30 (04) 433-438
  • 94 Bánhidy F, Acs N, Horváth-Puhó E, Czeizel AE. Pregnancy complications and delivery outcomes in pregnant women with severe migraine. Eur J Obstet Gynecol Reprod Biol 2007; 134 (02) 157-163
  • 95 Marozio L, Facchinetti F, Allais G. , et al. Headache and adverse pregnancy outcomes: a prospective study. Eur J Obstet Gynecol Reprod Biol 2012; 161 (02) 140-143
  • 96 Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RB. Perimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache 2016; 56 (02) 292-305
  • 97 MacGregor A. Effects of oral and transdermal estrogen replacement on migraine. Cephalalgia 1999; 19 (02) 124-125
  • 98 MacGregor EA. Perimenopausal migraine in women with vasomotor symptoms. Maturitas 2012; 71 (01) 79-82
  • 99 Silberstein SD, Merriam GR. Estrogens, progestins, and headache. Neurology 1991; 41 (06) 786-793
  • 100 North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause 2004; 11 (01) 11-33
  • 101 Ripa P, Ornello R, Degan D. , et al. Migraine in menopausal women: a systematic review. Int J Womens Health 2015; 7: 773-782
  • 102 Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001; 41 (07) 646-657
  • 103 Wang SJ, Fuh JL, Lu SR, Juang KD, Wang PH. Migraine prevalence during menopausal transition. Headache 2003; 43 (05) 470-478
  • 104 Kurth T. Migraine with aura and ischemic stroke: which additional factors matter?. Stroke 2007; 38 (09) 2407-2408
  • 105 MacClellan LR, Giles W, Cole J. , et al. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke 2007; 38 (09) 2438-2445
  • 106 Abanoz Y, Gülen Abanoz Y, Gündüz A. , et al. Migraine as a risk factor for young patients with ischemic stroke: a case-control study. Neurol Sci 2017; 38 (04) 611-617
  • 107 Collaborative Group for the Study of Stroke in Young Women. Oral contraceptives and stroke in young women. Associated risk factors. JAMA 1975; 231 (07) 718-722
  • 108 Spector JT, Kahn SR, Jones MR, Jayakumar M, Dalal D, Nazarian S. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med 2010; 123 (07) 612-624
  • 109 Chang CL, Donaghy M, Poulter N. ; The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Migraine and stroke in young women: case-control study. BMJ 1999; 318 (7175): 13-18
  • 110 Davis PH. Use of oral contraceptives and postmenopausal hormone replacement: evidence on risk of stroke. Curr Treat Options Neurol 2008; 10 (06) 468-474
  • 111 Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain 2012; 13 (03) 177-189
  • 112 Fazio G, Ferrara F, Barbaro G. , et al. Protrhombotic effects of contraceptives. Curr Pharm Des 2010; 16 (31) 3490-3496
  • 113 Edlow AG, Bartz D. Hormonal contraceptive options for women with headache: a review of the evidence. Rev Obstet Gynecol 2010; 3 (02) 55-65
  • 114 Xu Z, Li Y, Tang S, Huang X, Chen T. Current use of oral contraceptives and the risk of first-ever ischemic stroke: a meta-analysis of observational studies. Thromb Res 2015; 136 (01) 52-60
  • 115 Calhoun A. Combined hormonal contraceptives: is it time to reassess their role in migraine?. Headache 2012; 52 (04) 648-660
  • 116 Tepper D. Aura with headache. Headache 2014; 54 (06) 115-116