Sympathetic reactivity in patients suffering from menstrual migraine has been evaluated by means of blood pressure, heart rate and catecholamine monitoring during the tilt-table test performed either in the follicular or in the luteal phase of menstrual cycle. A sympathoadrenal activation mainly described by increased plasma epinephrine levels, has been documented in menstrual migraine not only during the luteal period but also in the early phases of migraine attacks. On the other hand, the interval phases seem to be characterized by a sympathetic chronic hypofunction. Variations in catecholaminergic reactivity are discussed as factors conditioning headache pathophysiology and attack epiphenomena.