Treatment Options for Migraine with Aura Influenced by Estrogen

Introduction to Migraine with Aura and Estrogen Relationship

Women with migraine with aura have a significantly increased risk of ischemic stroke compared to those without aura 3

The American Academy of Neurology recommends propranolol (80-160 mg oral once or twice daily in long-acting formulations) as a first-line treatment for migraine prevention 1, 2, 4
The American Academy of Neurology also recommends metoprolol (50-100 mg oral twice daily or 200 mg modified-release oral once daily) as a first-line treatment for migraine prevention 2, 4
Topiramate (50-100 mg oral daily) is recommended as a first-line treatment for migraine prevention, but is contraindicated in nephrolithiasis, pregnancy, lactation, and glaucoma 2, 4

The American College of Obstetricians and Gynecologists and the American Headache Society recommend that combined hormonal contraceptives are contraindicated in women with migraine with aura due to increased stroke risk 1, 2, 3
For women with pure menstrual migraine without aura, continuous use of combined hormonal contraceptives may be beneficial, according to the American College of Obstetricians and Gynecologists 2

The American Academy of Neurology recommends NSAIDs (ibuprofen, naproxen, diclofenac) as a first-line treatment for acute migraine attacks 5
Triptans are recommended as a second-line treatment for acute migraine attacks, but should not be administered during the aura phase, according to the American Headache Society 5

The American Academy of Neurology recommends evaluating treatment response within 2-3 months after initiation or change in treatment, and using headache calendars to track attack frequency, severity, and medication use 1
Key outcome measures include attack frequency (headache/migraine days per month), attack severity, and migraine-related disability, as recommended by the American Headache Society 1