The authors of this review are internationally renowned experts on the relationship of female hormonal physiology and migraine. This review is a necessary and useful counterpoint to the traditional view of improvement of migraine during pregnancy. They point out that the overlap of migraine and pregnancy as pro-thrombotic events raise risks for cardiac, cerebrovascular, and more systemic vascular pathologic occurrences. The overlap is dramatically illustrated by the authors in a figure pointing out that migraine is associated with increased platelet activation and aggregability and probably by higher prevalence of coagulation factors, and pregnancy is accompanied by increased estrogen-induced liver and placenta production of Factors I, II, VII, VIII, X, XII, von Willebrand’s factor, and other pro-coagulants with reduction of anti-coagulants such as t-PA. This mixture, along with other clinical features, is cause for heightened surveillance by clinicians even in the setting of decreased migraine attacks. —Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH