Focus on Primary Care

Women experience unique changes in headache pattern related to changes in their reproductive cycles.Changes predictably occur in association with menarche, menstrual cycling, the use of oral contraceptives, pregnancy, and menopause. These predictable headache changes are linked to changing levels of sex hormones. This article describes important relationships between estradiol and neurotransmitters involved in the pathogenesis of headache, such as serotonin. Treatment of headache in women includes the use of acute care and preventive treatments. The effectiveness of both medication and nonmedication treatments is reviewed. Also, unique aspects of treating headache with menstruation, pregnancy, and menopause are described. Target Audience Obstetricians & Gynecologists, Family Physicians Learning Objectives After completion of this article, the reader will be able to understand the incidence and prevalence of headaches in women, the different types of headaches and how they differ from each other, and be aware of the various treatment strategies for each of the various types of headaches.