Hormonal Manipulation Strategies in the Management of Menstrual Migraine and Other Hormonally Related Headaches

Shuster, Lynne T.; Faubion, Stephanie S.; Sood, Richa; Casey, Petra M.

doi:10.1007/s11910-010-0174-7

Cited by 25 publications

(22 citation statements)

References 46 publications

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“…Interestingly, a growing body of evidence suggests that it is not just the levels of gonadal hormones that are the problem, but fluctuations in hormone levels, in particular the drop in 17␤-estradiol that occurs with ovulation that may be the most effective trigger for migraine (Shuster et al 2011). These clinical data raise the intriguing possibility that acute deprivation of estrogens associated with the harvest and dissociation of dural afferents from female rats may contribute to the higher proportion of afferents sensitized by IM from females compared with males.…”

Section: Discussionmentioning

confidence: 99%

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Sex differences in the inflammatory mediator-induced sensitization of dural afferents

Scheff

Gold

2011

Journal of Neurophysiology

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Scheff NN, Gold MS. Sex differences in the inflammatory mediatorinduced sensitization of dural afferents. J Neurophysiol 106: 1662-1668, 2011. First published July 13, 2011 doi:10.1152 doi:10. /jn.00196.2011 of the adult population suffers from migraine. This debilitating pain disorder is three times more prevalent in women than in men. To begin to evaluate the underlying mechanisms that may contribute to this sex difference, we tested the hypothesis that there is a sex difference in the inflammatory mediator (IM)-induced sensitization of dural afferents. Acutely dissociated retrogradely labeled dural afferents from adult Sprague-Dawley rats were examined with whole cell patchclamp recordings. Baseline passive and active electrophysiological properties of dural afferents from both sexes were comparable. However, while IM-induced increases in the excitability of dural afferents from male and female rats were also comparable, the proportion of dural afferents from female rats sensitized by IM (ϳ100%) was significantly greater than that of dural afferents from male rats (ϳ50%). This appeared to be due to differences downstream of IM receptors, as tetrodotoxinresistant sodium current was increased by IM in a majority of male dural afferents (13/14). These data indicate that there are both quantitative and qualitative differences in the IM-induced sensitization of dural afferents that may contribute to the sex difference in the manifestation of migraine.trigeminal ganglion neuron; current clamp; primary afferent; chloride current; pain CONSERVATIVE ESTIMATES INDICATE that over 20% of the adult population suffers from migraine. Interestingly, this debilitating pain disorder is far more common in women than in men, with a prevalence roughly three times higher in women than in men [18% vs. 6% (Stewart et al. 1992)] and an incidence more than two times higher [43% vs. 18% (Stewart et al. 2008)]. The underlying mechanisms of this sex difference have yet to be identified.While there is still debate over the mechanisms underlying the initiation of a migraine attack, compelling evidence indicates that activation of primary afferents innervating the dural vasculature mediates migraine pain. Electrical stimulation of the dura and associated vasculature is associated with mi-

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Section: Discussionmentioning

confidence: 99%

“…Sex differences in the inflammatory mediatorinduced sensitization of dural afferents. J Neurophysiol 106: 1662-1668, 2011. First published July 13, 2011 doi:10.1152 doi:10.…”

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confidence: 99%

Sex differences in the inflammatory mediator-induced sensitization of dural afferents

Scheff

Gold

2011

Journal of Neurophysiology

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“…For example, menstrual migraine, migraine without aura associated with each menstrual period, is likely related to decreasing levels of estrogen in the luteal phase; 91,92 this syndrome represents 50% to 60% of women with migraines. 93 The incidence of migraine without aura during pregnancy decreases as the pregnancy progresses in most women. In the immediate postpartum period, though, patients continue to have fewer headaches but often experience an increase in headache intensity and duration.…”

Section: Gender Differences In Treatmentmentioning

confidence: 99%

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease

Madsen

Seigel²,

Mackenzie

et al. 2014

Acad Emerg Med

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Cerebrovascular neurologic emergencies including ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are leading causes of death and disability that are frequently diagnosed and treated in the emergency department (ED). Although sex and gender differences in neurologic emergencies are beginning to become clearer, there are many unanswered questions about how emergency physicians should incorporate sex and gender into their research initiatives, patient evaluations, and overall management plans for these conditions. After evaluating the existing gaps in the literature, a core group of ED researchers developed a draft of future research priorities. Participants in the 2014 Academic Emergency Medicine consensus conference neurologic emergencies working group then discussed and approved the recommended research agenda using a standardized nominal group technique. Recommendations for future research on the role of sex and gender in the diagnosis, treatment, and outcomes pertinent to ED providers are described for each of three diagnoses: stroke, SAH, and migraine. Recommended future research also includes investigation of the biologic and pathophysiologic differences between men and women with neurologic emergencies as they pertain to ED diagnoses and treatments.ACADEMIC EMERGENCY MEDICINE 2014;21:1403-1413 by the Society for Academic Emergency Medicine C erebrovascular neurologic emergencies such as ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are among the most lethal and disabling conditions presenting to the emergency department (ED). We have made great strides in understanding and treating these conditions, and our efforts have led to improved outcomes for these patients. Sex-and gender-based distinctions, however, are only recently becoming clearer, and much work is needed to explain the differences observed between men and women. After a focused review of the current literature on preclinical, clinical, and outcomes differences between women and men, and then the consensus process, we propose a research agenda in the areas of stroke, SAH, and headache/migraine. METHODSAfter evaluating the current literature, the authors, all emergency medicine (EM) researchers, proposed an agenda for future research. Consensus was reached using an iterative process through the four-part nominal group technique as already described in the executive summary. 1 A multidisciplinary group of participants (EM, critical care medicine, internal medicine, physical and rehabilitation medicine) prioritized the final iteration of themes/questions using the Poll Everywhere Web-based voting method. Descriptive statistics were calculated to tabulate the final list of questions presented below. The proposed research questions were then discussed and voted on by participants in the Academic Emergency Medicine consensus conference neurologic emergencies working group (see footnote for listing) at the meeting in May 2014. STROKE Epidemiology/OutcomesStroke is the fourth leading ca...

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“…11 If this woman had a previous history of migraine and uncomplicated migraine symptoms appeared during the pill-free week, management options would include adding a triptan when needed for symptoms, bridging with transdermal estrogen during the pill-free week, or switching to an extendedcycle pill regimen. 13 There is no proven benefit to the common practice of switching from triphasic to monophasic oral contraceptives in an effort to reduce headaches.…”

Section: Discussionmentioning

confidence: 99%

Clinical Pearls in Women's Health

Shuster

Bundrick

Litin

2012

Mayo Clinic Proceedings

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Hormonal Manipulation Strategies in the Management of Menstrual Migraine and Other Hormonally Related Headaches

Cited by 25 publications

References 46 publications

Sex differences in the inflammatory mediator-induced sensitization of dural afferents

Sex differences in the inflammatory mediator-induced sensitization of dural afferents

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease

Clinical Pearls in Women's Health

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