Sirs: Oestrogen replacement therapy is being increasingly used in the menopause to treat or prevent osteoporosis, to alleviate menopausal symptoms such as hot flushes, genitourinary symptoms, depression, and also with the intent of reduce the risk of cardiovascular disease [7, 8]. Because of so many proven or at least probable beneficial effects of such treatment, possible sideeffects or even contraindications may be overlooked. Within 3 years we have seen ten menopausal women (ie, about 3% of the 290 migraine patients seen during this time) using oestradiol cutaneous patches with a de-