Sex hormones such as estrogen play a role in migraine, researchers have long known. However, there has been little research on the mechanisms behind this role.

For example, do women with migraine have higher estrogen levels in general? Higher levels at the peak of the monthly cycle?

Now, research shows that, for women with a history of migraine, estrogen levels may drop more rapidly in the days just before menstruation than they do for women who do not have migraine history. For other hormone patterns, there were no differences between women with migraine and women who did not have migraine.

The study also found that the women with a migraine history had a faster rate of estrogen decline regardless of whether they had a migraine during that cycle.

Study author Jelena Pavlovic, MD, PhD, of Albert Einstein College of Medicine/Montefiore Medical Center, said:

“These results suggest that a ‘two-hit’ process may link estrogen withdrawal to menstrual migraine. More rapid estrogen decline may make women vulnerable to common triggers for migraine attacks such as stress, lack of sleep, foods and wine."

Hormone Levels

For the study, researchers reviewed migraine history, daily headache diaries and hormone data for 114 women with a history of migraine and 223 women without a history of migraine. The women were an average 47 years old.

The investigators measured hormone levels from daily urine samples for one monthly cycle; the participants' peak hormone levels, average daily levels and day-to-day rates of decline were calculated over the five days following each hormone peak in their cycles.

In the two days after the peak estrogen level in the luteal phase of the cycle, which is the time after ovulation and before menstruation, the estrogen levels in the women with migraine dropped by 40 percent compared to 30 percent for women without migraine. The rate dropped 34 picrograms per milligram of creatinine (pg/mgCr) in women with migraine, compared to 23 pg/mgCr in women without migraine.

“Future studies should focus on the relationship between headaches and daily hormone changes and explore the possible underpinnings of these results,” said Pavlovic.

While the study’s size and amount of hormone data are strengths, limitations include proportionately more Chinese and Japanese women in the group of women without migraine and more white and black women in the migraine group. The level of sex hormones may differ according to racial and ethnic differences.

Jelena M. Pavlović, Amanda A. Allshouse, Nanette F. Santoro, Sybil L. Crawford, Rebecca C. Thurston, Genevieve S. Neal-Perry, Richard B. Lipton, and Carol A. Derby Sex hormones in women with and without migraine: Evidence of migraine-specific hormone profiles Neurology 10.1212/WNL.0000000000002798; doi:10.1212/WNL.0000000000002798: 1526-632X

Image: Grace Walzel

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