Migraine and Estrogen
Migraine and Estrogen
Purpose of review The aim is to systematically and critically review the relationship between migraine and estrogen, the predominant female sex hormone, with a focus on studies published in the last 18 months.
Recent findings Recent functional MRI (fMRI) studies of the brain support the existence of anatomical and functional differences between men and women, as well as between participants with migraine and healthy controls. In addition to the naturally occurring changes in endogenous sex hormones over the lifespan (e.g. puberty and menopause), exogenous sex hormones (e.g. hormonal contraception or hormone therapy) also may modulate migraine. Recent data support the historical view of an elevated risk of migraine with significant drops in estrogen levels. In addition, several lines of research support that reducing the magnitude of decline in estrogen concentrations prevents menstrually related migraine (MRM) and migraine aura frequency.
Summary Current literature has consistently demonstrated that headache, in particular migraine, is more prevalent in women as compared with men, specifically during reproductive years. Recent studies have found differences in headache characteristics, central nervous system anatomy, as well as functional activation by fMRI between the sexes in migraine patients. Although the cause underlying these differences is likely multifactorial, considerable evidence supports an important role for sex hormones. Recent studies continue to support that MRM is precipitated by drops in estrogen concentrations, and minimizing this decline may prevent these headaches. Limited data also suggest that specific regimens of combined hormone contraceptive use in MRM and migraine with aura may decrease both headache frequency and aura.
Substantial research has emerged in the recent years highlighting sex differences in the epidemiology and characteristics of various headache disorders, specifically in migraine. The cause underlying these sex differences is likely multifactorial, involving both biological and psychosocial factors. Of the many biological factors, sex hormones are likely a major contributor. In addition to differences between men and women, migraine prevalence rates and characteristics vary in women by hormonal status (i.e. across the menstrual cycle, with or without taking hormonal contraceptives), further underscoring a strong role for sex hormones in headache.
Although the association between migraine and sex hormones has been repeatedly demonstrated, the exact pathophysiology of this association has not yet been fully elucidated. Further, for many clinicians, the effect of various hormonal contraceptive agents on migraine, specifically migraine with aura (MwA) continues to be a source of confusion. In this review, we first briefly discuss the most recent epidemiologic data evaluating sex differences in migraine. We then systematically and critically review the available clinical and experimental studies published in the last 18 months examining the role of estrogen, the predominant female sex hormone, in migraine. We close with a brief discussion on future directions necessary to further elucidate the role of estrogen and sex hormones in migraine.
Abstract and Introduction
Abstract
Purpose of review The aim is to systematically and critically review the relationship between migraine and estrogen, the predominant female sex hormone, with a focus on studies published in the last 18 months.
Recent findings Recent functional MRI (fMRI) studies of the brain support the existence of anatomical and functional differences between men and women, as well as between participants with migraine and healthy controls. In addition to the naturally occurring changes in endogenous sex hormones over the lifespan (e.g. puberty and menopause), exogenous sex hormones (e.g. hormonal contraception or hormone therapy) also may modulate migraine. Recent data support the historical view of an elevated risk of migraine with significant drops in estrogen levels. In addition, several lines of research support that reducing the magnitude of decline in estrogen concentrations prevents menstrually related migraine (MRM) and migraine aura frequency.
Summary Current literature has consistently demonstrated that headache, in particular migraine, is more prevalent in women as compared with men, specifically during reproductive years. Recent studies have found differences in headache characteristics, central nervous system anatomy, as well as functional activation by fMRI between the sexes in migraine patients. Although the cause underlying these differences is likely multifactorial, considerable evidence supports an important role for sex hormones. Recent studies continue to support that MRM is precipitated by drops in estrogen concentrations, and minimizing this decline may prevent these headaches. Limited data also suggest that specific regimens of combined hormone contraceptive use in MRM and migraine with aura may decrease both headache frequency and aura.
Introduction
Substantial research has emerged in the recent years highlighting sex differences in the epidemiology and characteristics of various headache disorders, specifically in migraine. The cause underlying these sex differences is likely multifactorial, involving both biological and psychosocial factors. Of the many biological factors, sex hormones are likely a major contributor. In addition to differences between men and women, migraine prevalence rates and characteristics vary in women by hormonal status (i.e. across the menstrual cycle, with or without taking hormonal contraceptives), further underscoring a strong role for sex hormones in headache.
Although the association between migraine and sex hormones has been repeatedly demonstrated, the exact pathophysiology of this association has not yet been fully elucidated. Further, for many clinicians, the effect of various hormonal contraceptive agents on migraine, specifically migraine with aura (MwA) continues to be a source of confusion. In this review, we first briefly discuss the most recent epidemiologic data evaluating sex differences in migraine. We then systematically and critically review the available clinical and experimental studies published in the last 18 months examining the role of estrogen, the predominant female sex hormone, in migraine. We close with a brief discussion on future directions necessary to further elucidate the role of estrogen and sex hormones in migraine.
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