Table 2 Diagnostic criteria according to the International Classification of Headache Disorders, II edition, for exogenous hormone-induced headache and estrogen-withdrawal headache

8.3.1 Exogenous hormone-induced headache

Diagnostic criteria

 A. Headache or migraine fulfilling criteria C and D

 B. Regular use of exogenous hormones

 C. Headache or migraine develops or markedly worsens within 3 months commencing exogenous hormones

 D. Headache or migraine resolves or reverts to its previous pattern within 3 months after total discontinuation of exogenous hormones

Comments: regular use of exogenous hormones, typically for contraception or hormone replacement therapy, can be associated with increase in frequency or new development of headache or migraine. When a woman experiences headache or migraine associated with exogenous estrogen-withdrawal, both codes 8.3.1 exogenous hormone-induced headache and 8.4.3 estrogen withdrawal headache should be used

8.4.3 Estrogen-withdrawal headache

Diagnostic criteria

 A. Headache or migraine fulfilling criteria C and D

 B. Daily use of exogenous estrogen for ≥3 weeks, which is interrupted

 C. Headache or migraine develops within 5 days after last use of estrogen

 D. Headache or migraine resolves within 3 days

Comments: estrogen-withdrawal following cessation of a course of exogenous estrogens (such as during the pill-free interval of combined oral contraceptives or following a course of replacement or supplementary estrogen) can induce headache and/or migraine