Objective To systemically review clinical studies investigating the role of prolactin and its receptors in headache and migraine. Background Migraine prevalence is more common in women compared to men. As prolactin is a crucial regulator of the hypothalamus-pituitary-gonadal axis, prolactin and its receptors might contribute to signaling mechanisms underlying migraine. Methods In this systematic review, we searched PubMed and EMBASE with the terms: prolactin, hyperprolactinemia, macroprolactinemia, hypoprolactinemia, migraine, headache, head pain and trigeminal pain pathway for clinical studies investigating prolactin signaling in headache and migraine. Two reviewers independently screened 841 articles for population, intervention, comparison, outcome, and study design. Studies were restricted to the English language and were excluded if they had a nonexperimental methodology. Results Nineteen clinical studies met the inclusion criteria and were included in the qualitative and quantitative analysis. The main findings were that serum prolactin levels were found to be higher in individuals with migraine compared to healthy controls, and prolactinomas (prolactin-secreting pituitary adenomas) were correlated with higher incidence of headache in otherwise healthy individuals and migraine attacks in individuals with migraine. Conclusion Considerable evidence suggests a key role of prolactin and its receptors in migraine pathophysiology. Further randomized and placebo-controlled clinical studies targeting prolactin signaling are needed to further clarify influences of prolactin in migraine attack initiation.
Objective To systemically review preclinical studies investigating the implication of prolactin signaling in headache and migraine pathophysiology. Background The features of migraine attacks, including characteristics, duration, frequency, and prevalence, are sex‐dependent with variability across a lifetime, indicating the involvement of the hypothalamus‐pituitary‐gonadal axis. Prolactin is a key regulator of this axis, and a new line of evidence implicates prolactin signaling in sex‐related differences in pain perception. Methods In this systematic review, we searched PubMed and EMBASE for the terms prolactin, hyperprolactinemia, macroprolactinemia, hypoprolactinemia, migraine, headache, head pain, and trigeminal pain pathway to find preclinical studies investigating prolactin signaling in headache and migraine. Two reviewers independently screened 841 articles for population, intervention, comparison, outcome, and study design. Studies were restricted to the English language and were excluded if they had a nonexperimental methodology. Results Of a total of 15 preclinical articles selected, 11 were both ex vivo and in vivo, 3 were ex vivo, and 1 was an in vivo study. The main findings were that prolactin receptors are distributed in the trigeminal pain pathway, and prolactin induced migraine‐like behavior in rodents. Moreover, prolactin signaling has a crucial role in calcitonin gene–related peptide (CGRP) release, a key molecule in migraine pathogenesis, and prolactin gene deletion attenuated CGRP‐induced migraine‐like behavior. Conclusion Preclinical data indicate a key role of prolactin and its receptors in mechanisms causing migraine. Further randomized and placebo‐controlled clinical studies targeting prolactin signaling are needed to further clarify the influences of prolactin in migraine‐attack initiation.
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