The complex relationship between estrogen and migraines: a scoping review

Abstract

Background Migraines are a chronic disease for millions worldwide and have been hypothesized to be hormonally mediated due to their higher prevalence in females and menstrual associations. Estrogen has been commonly implicated in migraine pathogenesis, yet its exact role in the pathophysiology of migraines has yet to be fully understood. Method We conducted a scoping review of the literature regarding estrogen’s role in migraine pathogenesis and included 19 studies out of an initial 202 in the final review. Two independent reviewers screened and extracted data from included studies based on predetermined inclusions and exclusion criteria. Results The estrogen withdrawal hypothesis, discussed by 12 of the reviewed studies, is the most discussed theory about estrogen’s role in migraine physiology and describes the association of migraine onset with natural declines in estrogen levels, particularly when estrogen levels fall below 45–50 pg/mL after an extended period of priming. Additional findings suggest that women with a history of migraine have an increased sensitivity to physiologic fluctuations in estradiol levels. Several studies suggest that migraines are associated with menstruation. Conclusion It appears that estrogen is very likely to play a key role in migraine pathogenesis, but seems to affect patients in different ways depending on their past medical history, age, and use of hormonal therapy. Further research is warranted to isolate the effects of estrogen in each unique patient population, and we believe that studies comparing menstruating women to postmenopausal women could help shed light in this area.

Assessing the Relationship between Obesity and Trigger Point-specific Outcomes after Headache Surgery

“…[32][33][34] Furthermore, obesity has also been shown to alter dural levels of calcitonin gene related peptide and modulate estrogen metabolism, both of which have been linked to migraine pathology. [35][36][37][38] Interestingly, however, the results of our study do not reflect an influence of this shared pathology. Compared with the differential responses reported after medication use, the present inconsistency begs the question whether a unique relationship between obesity and trigger point deactivation surgery exists, and if so, why?…”

Efeito da técnica de agulhamento a seco associado à eletroestimulação em estudantes com migrânea

“…De acordo com Reddy et al (2021) em uma revisão, a flutuação dos níveis do hormônio estrogênio pode desencadear a migrânea. Sendo essa a hipótese mais discutida na literatura referente a relação entre a migrânea e a ação do hormônio estrógeno, porém vale ressaltar que o seu papel na fisiopatologia da migrânea ainda não foi totalmente compreendido.…”

Migraine and thyroid dysfunction: Co‐occurrence, shared genes and biological mechanisms

“…Numerous studies have suggested an important role of oestrogen in migraine pathogenesis, but how it specifically affects migraine is still unclear. A recent review studying their complex relationship suggested that oestrogen levels affect patients depending on their TA B L E 3 Genome-wide significant thyroid SNPs associated with migraine medical history, age and hormonal therapy [100]. Thyroid dysfunction traits have shown sex-specific incidence with 5%-20% higher susceptibility in females compared to males, although the underlying mechanism is not yet known [101].…”