In women migraineurs, the female sex hormones, progestins and estrogens, exert a profound influence on the number and severity of migraine headaches. Why this occurs, and the mechanisms involved, remains unclear. Menstrual migraines generate an enormous amount of suffering because they tend to be more severe than nonmenstrually related headaches. In addition, they are often resistant to the usual migraine medication strategies. Headaches often decline in severity during pregnancy, but when present they are difficult to treat, because of the limited number of safe medications available. During menopause, headaches may follow any pattern, and they often improve after this time. When women require hormone replacement therapy, there are certain hormonal approaches that may help limit the headaches. Oral contraceptives may induce or exacerbate headache, or, less often, the headaches may improve. The majority of the time, the birth control pill does not influence migraine; however, it is important to be aware of the possibility of migraine exacerbation with the oral contraceptives.