The role of estradiol withdrawal in the etiology of menstrual migraine

Somerville, Brian W.

doi:10.1212/wnl.22.4.355

Cited by 361 publications

(266 citation statements)

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“…More than 50% of women relate a periodicity of their migraine attacks to their menstrual cycles [3,4], although in most cases they also have migraine attacks outside the menstrual period. It has been proposed that menstrual migraine is due to oestrogen withdrawal in the late luteal phase of the normal menstrual cycle acting as a migraine trigger in predisposed individuals [5], but other factors such as prostaglandin release have also been implicated [6]. However, the true prevalence of menstrual migraine attacks (those occurring during the peri-menstrual period) is unclear due to retrospective reports and variable definitions of menstrual migraine [7].…”

Section: Introductionmentioning

confidence: 99%

Managing migraine headaches experienced by patients who self–report with menstrually related migraine: a prospective, placebo–controlled study with oral sumatriptan

2005

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IntroductionMigraine is equally common in both genders until puberty, when it becomes approximately three times more prevalent in women than in men [1,2]. This greater prevalence in women is due, in part, to the influence of female sexual hormones. More than 50% of women relate a periodicity of their migraine attacks to their menstrual cycles [3,4], although in most cases they also have migraine attacks outside the menstrual period. It has been proposed that menstrual migraine is due to oestrogen withdrawal in the late luteal phase of the normal menstrual cycle acting as a migraine trigger in predisposed individuals [5], but other factors such as prostaglandin release have also been implicated [6]. However, the true prevalence of menstrual migraine attacks (those occurring during the peri-menstrual period) is unclear due to retrospective reports and variable definitions of menstrual migraine [7].Menstrual migraine attacks are treated with standard acute therapies and with specific prophylactic treatments such as oestrogen supplements taken during the peri-menstrual period [6]. It has been widely considered that menstrual migraine attacks are more severe and less responsive to drug treatments and non-pharmacological approaches than non-menstrual attacks [6,8], but the data to support this J Headache Pain (2005) 6:81-87 DOI 10.1007 Managing migraine headaches experienced by patients who self-report with menstrually related migraine: a prospective, placebo-controlled study with oral sumatriptan Abstract The objective was to evaluate the efficacy and tolerability of oral sumatriptan (100 mg) in patients who self-reported with menstrually related migraine. A prospective, multicentre, randomised, double-blind, placebocontrolled, two-group crossover study was carried out in 20 UK primary and secondary care surgeries. Of 115 patients with a self-reported history of menstrually related migraine that entered the study, 93 patients completed it. Patients treated all migraine attacks for 2 months with sumatriptan (100 mg) and for 2 months with placebo. The primary endpoint was the proportion of patients reporting headache relief at 4 hours for the first treated attack.Only 11% of patients fulfilled the protocol definition of menstrually related migraine. Patients reported a variable pattern of migraine attacks occurring inside and outside the menstrual window. For the first attack, significantly more patients receiving sumatriptan than placebo reported headache relief for attacks occurring inside (67% vs. 33%, p=0.007) and outside (79% vs. 31%, p<0.001) the menstrual period. Sumatriptan was generally well tolerated. Oral sumatriptan (100 mg) is an effective and well tolerated acute treatment for patients who report menstrually related migraine.

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Section: Introductionmentioning

confidence: 99%

Managing migraine headaches experienced by patients who self–report with menstrually related migraine: a prospective, placebo–controlled study with oral sumatriptan

2005

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“…[1][2][3] For the majority of women with migraine, headache attacks are more likely during the 2 days preceding the onset of menstrual bleeding and for the first 3 days of menses. [4][5][6][7] These perimenstrual attacks are commonly labeled menstrual migraine and, according to the "estrogen withdrawal" migraine-triggering hypothesis, [8][9][10] are thought to be attributable to estrogen decline in the late luteal phase (figure 1). 9,10 Although the role of hormones in migraine has long been implicated, there are limited data regarding menstrual hormonal patterns in women with migraine [10][11][12][13][14] and even fewer studies comparing hormone levels and patterns between women with history of migraine (MHx) and controls.…”

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Sex hormones in women with and without migraine

et al. 2016

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Objective: To compare daily sex hormone levels and rates of change between women with history of migraine and controls.Methods: History of migraine, daily headache diaries, and daily hormone data were collected in ovulatory cycles of pre-and early perimenopausal women in the Study of Women's Health Across the Nation. Peak hormone levels, average daily levels, and within-woman day-to-day rates of decline over the 5 days following each hormone peak were calculated in ovulatory cycles for conjugated urinary estrogens (E1c), pregnanediol-3-glucuronide, luteinizing hormone, and follicle-stimulating hormone. Comparisons were made between migraineurs and controls using 2-sample t tests on the log scale with results reported as geometric means.Results: The sample included 114 women with history of migraine and 223 controls. Analyses of within-woman rates of decline showed that E1c decline over the 2 days following the luteal peak was greater in migraineurs for both absolute rate of decline (33.8 [95% confidence interval 28.0-40.8] pg/mgCr vs 23.1 [95% confidence interval 20.1-26.6] pg/mgCr, p 5 0.002) and percent change (40% vs 30%, p , 0.001). There was no significant difference between migraineurs and controls in absolute peak or daily E1c, pregnanediol-3-glucuronide, luteinizing hormone, and follicle-stimulating hormone levels. Secondary analyses demonstrated that, among migraineurs, the rate of E1c decline did not differ according to whether a headache occurred during the cycle studied.Conclusions: Migraineurs are characterized by faster late luteal phase E1c decline compared to controls. The timing and rate of estrogen withdrawal before menses may be a marker of neuroendocrine vulnerability in women with migraine. Neurology ® 2016;87:49-56 GLOSSARY BMI 5 body mass index; DHS 5 Daily Hormone Study; E1c 5 conjugated urinary estrogens; ELA 5 evidence of luteal activity; FSH 5 follicle-stimulating hormone; ICHD 5 International Classification of Headache Disorders; LH 5 luteinizing hormone; MHx 5 women with history of migraine; Pdg 5 pregnanediol-3-glucuronide; SWAN 5 Study of Women's Health Across the Nation.

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“…Maintaining luteal phase oestrogen levels can prevent menstrual attacks [MacGregor et al 2006;Somerville, 1975aSomerville, , 1975bSomerville, , 1972. Doses equivalent to 1.5 mg estradiol gel allow a mean estradiol plasma level of 80 pg/ml to be reached.…”

Section: Estradiolmentioning

confidence: 99%

Review: Menstrual migraine: therapeutic approaches

MacGregor

2009

Ther Adv Neurol Disord

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The development of diagnostic criteria has enabled greater recognition of menstrual migraine as a highly prevalent and disabling condition meriting specific treatment. Although few therapeutic trials have yet been undertaken in accordance with the criteria, the results of those published to date confirm the efficacy of acute migraine drugs for symptomatic treatment. If this approach is insufficient, the predictability of attacks provides the opportunity for perimenstrual prophylaxis. Continuous contraceptive strategies provide an additional option for management, although clinical trial data are limited. Future approaches to treatment could explore the genomic and nongenomic actions of sex steroids.

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The role of estradiol withdrawal in the etiology of menstrual migraine

Cited by 361 publications

References 0 publications

Managing migraine headaches experienced by patients who self–report with menstrually related migraine: a prospective, placebo–controlled study with oral sumatriptan

Managing migraine headaches experienced by patients who self–report with menstrually related migraine: a prospective, placebo–controlled study with oral sumatriptan

Sex hormones in women with and without migraine

Review: Menstrual migraine: therapeutic approaches

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