Headache is a common reason for internal medicine outpatients to visit the clinic, the etiology and classification are complex, and it is not easy to make a clear diagnosis. In the last decade, with the change of recipes, social pressure and mental problems, the number of headache patients has increased year after year. The World Health Organization lists severe headache as one of the top 10 most disabling diseases, and in women it is among the top 5. Female migraines are closely related to changes in the development of the reproductive system, which according to studies can be identified at menarche, menstruation, pregnancy, menopause and the application of oral contraceptives. During these special physiological stages, changes in the level of sex hormones in the female body cause the onset or nature of migraine. Menstrual migraine is mostly migraine without aura, and the attack usually lasts for a long time, up to 4~5 days, which is comparable to the duration of menstruation. Menstrual migraine can occur before, after or during menstruation. Many menstrual migraine sufferers experience an exacerbation during ovulation, and migraine attacks are common at other times during the non-menstrual period. Menstrual migraine can be categorized into simple menstrual migraine without aura and menstrual-related migraine without aura. Treatment for menstrual migraine attacks is the same as for regular migraine attacks. For severe menstrual migraines, stronger pain medications are often needed. Steroids are more effective. Triptans are also effective in aborting menstrual migraine attacks. Intramuscular or nasal DHE is effective in some patients. If these treatments are ineffective and symptoms are severe, concomitant use of pethidine and antiemetics may be considered. The prophylactic treatment of menstrual migraine includes short-term prophylaxis and continuous prophylaxis. The former, which is administered only during the attack-prone period, is shorter in duration and more acceptable to the patient. Drugs with evidence of short-term prophylaxis include NSAIDs, treprostinil, magnesium, and hormone replacement therapy. 2, sex hormones and headache The changes in the form of headache in women during their reproductive years are related to changes in the level of sex hormones in the body. Migraine attacks associated with menstruation occurs in the body of estrogen and progesterone levels decrease in the period, when supplemental estrogen can prevent menstrual migraine attacks, while supplemental progesterone does not have this effect. Headaches often occur or worsen in other situations where estrogen levels decrease, such as ovulation, labor, and early withdrawal of contraceptives. Headaches tend to resolve during pregnancy due to increased estrogen levels. It is now believed that estrogen can cause headaches by directly affecting the morphology and function of nerve cells. Morphologic studies have found that the distribution of sex hormone receptors in the brain is closely related to the distribution of neurotransmitter receptors in migraine attacks. 50% to 80% of the brain bridges and medulla oblongata have estradiol receptors in the sites of catecholamine receptor distribution, and the blue spot is also rich in estradiol receptors. Sex hormones have an effect on the morphology of nerves, and the number of synapses in the adult brain changes accordingly with cyclic changes in sex hormone levels in the body. Estrogen increases the density of small spines on cell bodies and dendrites of nerve cells and the formation of newborn synapses. Increased estrogen levels also increase the pain threshold, the latter of which changes accordingly with the former. Peripheral serotonin levels decrease during migraine or tension headache. And peripheral serotonin levels coincide with estrogen levels when estrogen levels are elevated. Studies have demonstrated that peripheral serotonin levels decrease during ovulation, menstruation, and puerperium, and headaches worsen. In short, estrogen affects pain perception and headache-related neurochemical activities, causing clinical changes in women’s headache. 3, contraceptive drugs and headache The prevalence of migraine in women taking contraceptives is 10 times higher than that in women not taking contraceptives. Migraine patients who take contraceptives, the frequency of migraine attacks than those who do not take 18% to 50% higher. The frequency and severity of migraines decreases after discontinuing the pill, but this relief often occurs 1 year after discontinuing the pill. In other patients, there is no significant change in headache or headache relief after taking birth control pills. It is more common for headaches to be aggravated by taking estrogen-containing contraceptives, which is related to the fluctuation of estrogen levels in the body. 4, headache during pregnancy and lactation Headache during pregnancy is usually relieved, 48% of women with migraine headache reduction, 28% of women with tension headache reduction. However, it has been reported in the literature that some pregnant women have persistent headache in the first three months of pregnancy, and thereafter migraine or tension headache is often not significantly relieved. 39% to 58% of women in the perinatal headache worsened, of which 70% need to take pain medication. Some headaches worsen during pregnancy, and a few migraines begin during pregnancy. In patients with severe headaches during pregnancy, the first step is to rule out organic pathology. Treatment of migraine or chronic daily headache during pregnancy includes nonpharmacologic treatments such as local cold packs, relaxation therapies, and the application of small doses of medications, usually only for pain relief and not for prophylaxis if possible. Acetaminophen is the primary pain medication for Gestational headaches. The medication should also be used in conjunction with relaxation exercises, cold ice packs, and rest in a dimly lit room. Small doses of ibuprofen and naproxen may also be used. Some scholars use narcotic drugs, such as pethidine, codeine, morphine, etc., for severe headaches, but generally do not advocate frequent repeated use. Small doses of prednisone may also be used for severe intractable headaches. Ergotamine and treprostinil are generally not advocated. Antiemetic drugs such as vitamin B6, metoclopramide, and prochlorperazine may be applied to those with significant nausea and vomiting. Theophylline can also be applied and is relatively safe. Prophylactic treatment is only indicated in patients with very severe and frequent headaches during pregnancy. Depending on the accompanying symptoms, 5-hydroxytryptamine reuptake inhibitors, beta-blockers, and calcium channel blockers may be used. The use of β-blockers in pregnancy is relatively safe, but there are reports in the literature that β-blockers can cause intrauterine fetal developmental retardation. The basic principle of prevention and treatment of headache in pregnancy is not to take drugs as much as possible; if drugs are needed, they should be avoided in the first trimester of pregnancy and 3 weeks before delivery; patients should be fully informed of the adverse effects of the drugs and the possible adverse effects on the fetus before using them. The patient should be fully informed of the adverse effects of the drug and the possible adverse effects on the fetus before using the drug. If medication is needed, small doses of acetaminophen and non-steroidal anti-inflammatory drugs can be tried first. Sedatives, antihistamines, ergotamine and treprostinil are generally not recommended. Antiemetic drugs prochlorperazine can be used if necessary. For those with frequent and severe headache episodes, consideration should be given to the use of 顔 channel blockers, β-blockers, and the cautious use of antidepressants. 5.Perimenopausal headache In perimenopause, the degree and frequency of headache increases in some patients, and some patients’ headache relieves, while some patients’ headache form does not have obvious changes. When estrogen is applied to treat postmenopausal syndromes, it can cause either relief or exacerbation of headache. Patients with worsening symptoms can be treated by reducing the estrogen dosage to lower the value of the estrogen downward gradient, and by changing from cyclic to daily dosing to eliminate cyclic changes in estrogen in the body. If none of the above methods are effective, the estrogen dosage form can also be changed to treat the disease, in the order from conjugated estrogen, pure estradiol, synthetic estrogen to estrone. In addition, the addition of small doses of androgens may be useful for symptomatic relief.