Migraine in women: the role of hormones and their impact on vascular diseases

Abstract

Migraine is a predominantly female disorder. Menarche, menstruation, pregnancy, and menopause, and also the use of hormonal contraceptives and hormone replacement treatment may influence migraine occurrence. Migraine usually starts after menarche, occurs more frequently in the days just before or during menstruation, and ameliorates during pregnancy and menopause. Those variations are mediated by fluctuation of estrogen levels through their influence on cellular excitability or cerebral vasculature. Moreover, administration of exogenous hormones may cause worsening of migraine as may expose migrainous women to an increased risk of vascular disease. In fact, migraine with aura represents a risk factor for stroke, cardiac disease, and vascular mortality. Studies have shown that administration of combined oral contraceptives to migraineurs may further increase the risk for ischemic stroke. Consequently, in women suffering from migraine with aura caution should be deserved when prescribing combined oral contraceptives.Electronic supplementary materialThe online version of this article (doi:10.1007/s10194-012-0424-y) contains supplementary material, which is available to authorized users.

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

“…While an association between migraine and stroke has not been confirmed in migraine-without-aura patients, 97 the risk of both ischemic and hemorrhagic 98 stroke is two to three times higher in migraine-with-aura patients. There may, however, be other more profound vascular risks present in these patients who were not accounted for in the studies.…”

Headache frequency and intensity in female migraineurs using desogestrel-only contraception: A retrospective pilot diary study

“…This risk may further increase when combined oral contraceptives (COCs) are used for the prevention of pregnancy (4)(5)(6)(7). The cardiovascular risk of COCs, which contain ethinylestradiol and a synthetic progestin, has been mainly attributed to the oestrogen component which exerts a strong effect on the coagulation system.…”

Gestational headaches: characteristics and influencing factors in South-Western Nigeria

“…It has been postulated that the differing ability to metabolize estrogen as well as the existence of polymorphism in the genes encoding for sex hormones, their receptors, or metabolites of the hormonal pathways may be responsible for this differences in presentation and symptomatology during pregnancy. 20 For example, Colson et al 21 found a correlation between the polymorphism in progesterone receptors and the incidence of migraine.…”