New Theories in the pathogenesis of menstrual migraine

ArticleinCurrent Pain and Headache Reports 12(6):453-62 · January 2009with4 Reads
DOI: 10.1007/s11916-008-0077-3 · Source: PubMed
Hormonal and nonhormonal factors play a role in the pathophysiology of menstrual migraine, but estrogen withdrawal appears to be the most potent of these factors. It is postulated that estrogen withdrawal directly enhances excitability of trigeminal afferents, modulates the synthesis of neuropeptides, activates/deactivates specific neurotransmitter systems, and influences the function of microglia. These changes could activate and/or sensitize the trigeminal system and increase the likelihood of migraine headache during perimenstrual time periods. Three new theories are advanced in this article to explain the pathophysiology of menstrual migraine. Only through an understanding of the mechanisms involved in menstrual migraine can we gain insight into the management of this severe and debilitating form of migraine headache.
    • "Alternatively, it may not be the absolute level of E2 that is important, but changes in concentration (i.e., fluctuating levels during the estrous or menstrual cycle). Estrogen or progesterone withdrawal may be more significant in modulating nociceptive sensitivity than maintaining a high level of either hormone (Devall and Lovick, 2010; Heitkemper and Chang, 2009; Ji et al., 2003; Martin et al., 2007; Martin, 2008; Puri et al., 2011; Robbins et al., 2010). Finally, the site where hormones produce their effect, peripheral tissue or the central nervous system (CNS), likely influences any conclusions. "
    [Show abstract] [Hide abstract] ABSTRACT: Women disproportionately suffer from many deep tissue pain conditions. Experimental studies show that women have lower pain thresholds, higher pain ratings and less tolerance to a range of painful stimuli. Most clinical and epidemiological reports suggest female gonadal hormones modulate pain for some, but not all, conditions. Similarly, animal studies support greater nociceptive sensitivity in females in many deep tissue pain models. Gonadal hormones modulate responses in primary afferents, dorsal horn neurons and supraspinal sites, but the direction of modulation is variable. This review will examine sex differences in deep tissue pain in humans and animals focusing on the role of gonadal hormones (mainly estradiol) as an underlying component of the modulation of pain sensitivity.
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    • "Moreover , when physical symptoms are included, they are typically general in nature, or are grouped together into one single variable (e.g., Bloch et al., 1997; Freeman et al., 1985; Wittchen et al., 2002). Finally, although some research has examined specific physical symptoms of the menstrual cycle, including menstrual migraines (Martin, 2008) and dysmenorrhea (Dawood, 2006), research has failed to consider physical and psychological symptoms in a meaningfully integrated way. For example, do different physical symptoms show different types of associations with psychological symptoms? "
    [Show abstract] [Hide abstract] ABSTRACT: The associations between physical and psychological symptoms of the menstrual cycle have not been carefully studied in past research, but may lead to a better understanding of the underlying mechanisms of these symptoms. The present study examines the day-to-day co-variations among physical and psychological symptoms of the menstrual cycle. These symptoms were evaluated on a daily basis across one entire menstrual cycle, with a non-clinical sample of 92 university students. Results showed that headaches, gastrointestinal problems, lower abdominal bloating, skin changes, and breast changes, were all significantly associated with higher levels of psychological symptoms; whereas back and joint pain, lower abdominal cramps, cervical mucous, and menstrual flow, were not associated with psychological symptoms. However, significant differences in these associations were observed across individuals for back and joint pain, headaches, lower abdominal cramps, skin changes, and menstrual flow: Whereas some women demonstrated higher levels of psychological symptoms associated with these physical symptoms, other women demonstrated lower levels of psychological symptoms. Finally, correlations among the associations between physical and psychological symptoms (slopes) demonstrated clear differences across the different physical symptoms. These results indicate that, although higher levels of some physical symptoms are associated with higher levels of psychological symptoms, there are significant differences in the magnitude and direction of these relations across individuals. Further consideration of physical symptoms may provide useful information for understanding individual differences in symptom profiles and response to steroid fluctuations, and for improving differential diagnosis and treatment planning and evaluation.
    Full-text · Article · Oct 2010
  • [Show abstract] [Hide abstract] ABSTRACT: Hintergrund Die Migräne ist eine komplexe, invalidisierende Erkrankung, die überwiegend Frauen im reproduktiven Alter betrifft. Ziel bei betroffenen Frauen muss es sein, eine Verhütungsmethode zu finden, die weder mit einem erhöhten Insultrisiko assoziiert ist noch den Migräneverlauf negativ beeinflusst. Um dies zu erreichen, ist eine sorgfältige Anamnese zum Ausschluss weiterer kardiovaskulärer Risiken erforderlich. Kontrazeption mit Gestagenen Unter den hormonellen Methoden stehen die Gestagenmethoden an erster Stelle. Sie erhöhen das Risiko für einen Insult nicht. Für Desogestrel 75 μg gibt es zudem immer mehr Hinweise, dass es den Verlauf hormonabhängiger und -unabhängiger Migränen bei der Mehrzahl der Frauen positiv beeinflussen kann. Weitere Verfahren Kombinierte hormonelle Kontrazeptiva (KHK) sollten nur ausnahmsweise verordnet werden. Die Migräne mit Aura ist eine absolute Kontraindikation. Kupferfreisetzende Intrauterinpessare beeinflussen den Verlauf der Migräne nicht. Hormonentzugsmigränen unter KHK kann man mit dem Langzyklus positiv beeinflussen. Es bleibt aber unklar, was dies für das individuelle Risiko eines zerebralen Insults bedeutet. Daher sind Gestagene vorzuziehen.
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