Jan Lewis Brandes1. 1. Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tenn, USA. jbrandes@nashvilleneuroscience.com
Abstract
CONTEXT: Menstrual migraine affects approximately 50% to 60% of female migraineurs, but knowledge regarding the role of hormones, especially estrogen, appears incomplete. OBJECTIVE: To conduct a systematic review to determine the role of hormones on menstrual migraine. EVIDENCE ACQUISITION: MEDLINE (January 1966 through September 1, 2005) and EMBASE Drugs and Pharmacology (January 1991 through September 1, 2005) were searched for articles published in the English language using the keywords migraine, estrogen, menstrual migraine, pure menstrual migraine, true menstrual migraine, menstrually-associated migraine, menstrually-related migraine, pregnancy, breast-feeding, perimenopause, menopause, nitric oxide, and estrogen receptors. A total of 643 unique articles were reviewed for relevance, scientific rigor, and generalizability. For each relevant citation, the bibliography was reviewed to identify additional sources of pertinent data. EVIDENCE SYNTHESIS: The influence of estrogen on migraine is evident by a 3-fold greater prevalence among women compared with men, and by significant changes in migraine incidence with changes in female reproductive status. Menstrual migraines are usually more resistant to treatment, generally not associated with aura, of longer duration, and associated with more functional disability compared with attacks at other times of the month. Biochemical and genetic evidence suggest central and peripheral roles for estrogen in the pathophysiology of menstrual migraine, with potential interactions with excitatory circuits, including serotonergic components. Although evidence for estrogen as a preventive treatment for menstrual migraine is inconsistent, serotonin receptor agonists (triptans) provide acute relief and also may have a role in prevention. CONCLUSIONS: Epidemiological, pathophysiological, and clinical evidence link estrogen to migraine headaches. Triptans appear to provide acute relief and also may be useful for headache prevention. Clear, focused, and evidence-based treatment algorithms are needed to support primary care physicians, neurologists, and gynecologists in the treatment of this common condition.
CONTEXT: Menstrual migraine affects approximately 50% to 60% of female migraineurs, but knowledge regarding the role of hormones, especially estrogen, appears incomplete. OBJECTIVE: To conduct a systematic review to determine the role of hormones on menstrual migraine. EVIDENCE ACQUISITION: MEDLINE (January 1966 through September 1, 2005) and EMBASE Drugs and Pharmacology (January 1991 through September 1, 2005) were searched for articles published in the English language using the keywords migraine, estrogen, menstrual migraine, pure menstrual migraine, true menstrual migraine, menstrually-associated migraine, menstrually-related migraine, pregnancy, breast-feeding, perimenopause, menopause, nitric oxide, and estrogen receptors. A total of 643 unique articles were reviewed for relevance, scientific rigor, and generalizability. For each relevant citation, the bibliography was reviewed to identify additional sources of pertinent data. EVIDENCE SYNTHESIS: The influence of estrogen on migraine is evident by a 3-fold greater prevalence among women compared with men, and by significant changes in migraine incidence with changes in female reproductive status. Menstrual migraines are usually more resistant to treatment, generally not associated with aura, of longer duration, and associated with more functional disability compared with attacks at other times of the month. Biochemical and genetic evidence suggest central and peripheral roles for estrogen in the pathophysiology of menstrual migraine, with potential interactions with excitatory circuits, including serotonergic components. Although evidence for estrogen as a preventive treatment for menstrual migraine is inconsistent, serotonin receptor agonists (triptans) provide acute relief and also may have a role in prevention. CONCLUSIONS: Epidemiological, pathophysiological, and clinical evidence link estrogen to migraine headaches. Triptans appear to provide acute relief and also may be useful for headache prevention. Clear, focused, and evidence-based treatment algorithms are needed to support primary care physicians, neurologists, and gynecologists in the treatment of this common condition.
Authors: Umit H Ulas; Thomas C Chelimsky; Gisela Chelimsky; Aditya Mandawat; Kevin McNeeley; Amer Alshekhlee Journal: Clin Auton Res Date: 2010-05-11 Impact factor: 4.435
Authors: Wulf H Utian; David F Archer; Gloria A Bachmann; Christopher Gallagher; Francine n Grodstein; Julia R Heiman; Victor W Henderson; Howard N Hodis; Richard H Karas; Rogerio A Lobo; JoAnn E Manson; Robert L Reid; Peter J Schmidt; Cynthia A Stuenkel Journal: Menopause Date: 2008 Jul-Aug Impact factor: 2.953
Authors: Eydie L Moses-Kolko; Sarah L Berga; Brinda Kalro; Dorothy K Y Sit; Katherine L Wisner Journal: Clin Obstet Gynecol Date: 2009-09 Impact factor: 2.190
Authors: Anke C Winter; Kathryn M Rexrode; I-Min Lee; Julie E Buring; Rulla M Tamimi; Tobias Kurth Journal: Cancer Causes Control Date: 2012-11-10 Impact factor: 2.506
Authors: Robert W Mathes; Kathleen E Malone; Janet R Daling; Scott Davis; Sylvia M Lucas; Peggy L Porter; Christopher I Li Journal: Cancer Epidemiol Biomarkers Prev Date: 2008-11 Impact factor: 4.254