New Theories in the pathogenesis of menstrual migraine

Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
Current Pain and Headache Reports (Impact Factor: 2.26). 01/2009; 12(6):453-62. 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.

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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? "
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    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.
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    ABSTRACT: Most clinical pain disorders are more common in women than in men, particularly during the peak reproductive years. This suggests that fluctuations in the ovarian hormones encountered during the female menstrual cycle may increase pain response. This article examined whether pain severity and experimental pain thresholds vary during the phases of the menstrual cycle in women with and without clinical pain disorders. It also reviewed the effect of ovarian hormones on behavioral responses to painful stimuli (pain reactivity) in animal models and the potential mechanisms through which ovarian hormones modulate pain reactivity. A narrative review was performed to ascertain the relationship between ovarian hormones and pain response. Relevant English-language publications describing pain reactivity in premenopausal women and female rodents were identified through searches of MEDLINE and PubMed from January 1, 1967, through May 1, 2008, as well as through the reference lists of identified articles. In the clinical studies reviewed, most pain disorders were reported to worsen during the late luteal and early follicular phases of the menstrual cycle. Pain thresholds and tolerance times also varied during different phases of the menstrual cycle in healthy premenopausal women in the majority of studies. Basic science studies suggested that ovarian hormones have distinct effects-on inflammation, affective states, stress responses, modulatory pain systems, and afferent sensory systems-that increase or decrease pain reactivity. Fluctuations of ovarian hormones in the course of the menstrual cycle appear to be associated with a mild to moderate effect on pain response. Greater knowledge of the mechanisms by which ovarian hormones modulate pain would broaden our understanding of why pain disorders are more frequent, severe, and disabling in women than in men.
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