Migraine: is it related to hormonal disturbances or stress?

Abstract

BackgroundCommon neurological syndrome (migraine without aura) is more common among women than men. Migraine is among the top 20 causes of disability. Menstruation is known to be a powerful trigger for migraine, and so is stress, but the presentation of headache is similar in both. Also, women are more vulnerable to stress as well as migraine, and this makes a complex relationship of menstruation, stress, and migraine.ObjectiveThis study was done to understand the association of hormonal fluctuation in menstruation and stress with common migraine.Materials and methodsA cross-sectional comparative study was conducted in 40 young adult females, of whom 20 participants were cases of migraine without aura (18–35 years old), and the remaining 20 participants were age-matched controls. The study was done in Maulana Azad Medical College, New Delhi. Study participants were selected on the basis of International Headache Society (ICHD-IIA1.1) (2004) classification. Study participants with neurological disorders, chronic diseases, and disease suggestive of any hormonal disturbances were excluded. Clinically diagnosed migraine cases were asked to maintain a headache diary and to fill in the Depression Anxiety Stress Scales questionnaire. Biochemical assessment of hormonal status for thyroid-stimulating hormone, triiodothyronine, thyroxine, estrogen, follicle-stimulating hormone, luteinizing hormone, and prolactin was also done on the second day of their menstrual cycle. We used the Mann–Whitney U test to compare hormonal levels and the χ2 test to compare anxiety- or depression-related stress among the migraine and nonmigraine groups.ResultsSignificantly higher values of prolactin were observed in cases (mean ± standard deviation, 152.7 mIU/L±30.5) compared to controls (76.1 mIU/L±8.7), with a P-value <0.001. There was no statistically significant difference observed in levels of thyroid-stimulating hormone (P=0.081), estrogen (P=0.086), luteinizing hormone (P=0.091), or follicle-stimulating hormone (P=0.478). Also, anxiety with stress or depression with stress was significantly higher among the migraine group than the controls (P=0.002). Odds of any stress in migraine were higher in the migraine group than in the nonmigraine group (odds ratio 12, 95% confidence interval 2.7–53.33).ConclusionMigraine, particularly without aura, in women is mainly associated with stress-related anxiety or depression, and are more susceptible to stress in the premenstrual period.

Stress and Primary Headache: Review of the Research and Clinical Management

“…This study demonstrated that two consecutive days of either high stress or low sleep were strongly predictive of headache, whereas two days of low stress or adequate sleep were protective. Another study investigated stress and menstruation and migraine, and reported that migraine in women was mainly associated with stress, and women are more susceptible to stress in the premenstrual period [31].…”

Women Living Together Have a Higher Frequency of Menstrual Migraine

“…Third, the social factors involved need to be analyzed when studying menstrual synchrony and the presence of migraine among women. A study that compared menstrual factors and stress factors in the genesis of migraine, considering that women are frequently exposed to both situations, concluded that stress was a stronger trigger of migraine than menstruation in addition to sensitizing women to other factors triggering crises . In the present study, so‐called social factors such as diet, sleep deprivation, and stress were analyzed in a pain diary and considered to be confounding factors triggering crises of menstrual pain.…”

Menstrual Dönemde Ve Öncesi̇nde Temporomandi̇bular Eklem, Baş-Boyun, Yüz-Kulak Bölgesi̇ Ağrilarinin Görülme Sikliğinin Araştirilmasi: Pi̇lot Çalişma

“…32,33 Fakat migrenin stres kaynaklı olabileceği ve premenstrual dönemlerde strese daha duyarlı olunabileceği için menstruasyondan daha çok premenstrual dönemde gözlendiğini belirten çalıĢmalar da bulunmaktadır. 34 Balter ve ark'nın kronik boyun ağrısına sahip kadınlarda menstrual periyodun ağrı Ģiddetinde bir değiĢime yol açıp açmadığının araĢtırıldığı çalıĢmada, menstrual periyottaki ağrı artıĢının klinik olarak önemli bir seviyede olmadığı gözlenmiĢtir. 6 ÇalıĢmada da her iki grupta da en çok ağrı bildirilen bölge baĢ-boyun bölgesidir.…”