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Influential studies by Somerville implicated estrogen withdrawal as a trigger for menstrual migraine. However, the research was not definitive because of the small number of patients and the unblinded study design (Neurology 1975; 25:239). MacGregor and colleagues have redressed some of these deficiencies in two related studies.
First, they studied the association between daily urinary estrogen levels and diary-recorded headache attacks during three consecutive menstrual cycles in 38 women with menstrual migraine. Migraine incidence was lower than expected when estrogen levels were rising and higher than expected during the estrogen decline of the late luteal phase. There was no difference between expected and observed migraines during the p…