HORMONE-RELATED HEADACHE - 02/09/11
Résumé |
There is a link between the female sex hormones, estrogen and progesterone, and migraine.29, 77, 83, 86 Migraine occurs more frequently in women than in men, although prevalence is equal in prepubertal children. Migraine develops most frequently in the second decade, with the peak incidence occurring at adolescence.29, 77 Menstrually related migraine (MM) begins at menarche in 33% of affected women.29 MM occurs mainly at the time of menses in many migrainous women and exclusively with menses (true menstrual migraine [TMM]) in some.29 MM can be associated with other somatic complaints arising before and often persisting into menses, such as nausea, backache, breast tenderness, and cramps, and, similar to them, appears to be the result of falling sex hormone levels.4, 86 Premenstrual migraine can be associated with late luteal phase dysphoric disorder (premenstrual dysphoric disorder, also called premenstrual syndrome [PMS]), which is distinct from the physical symptoms of the perimenstrual period and probably is not driven directly by declining progesterone levels.59 Migraine occurring during (rather than before) menstruation usually is not associated with PMS.
Migraine often worsens during the first trimester of pregnancy. Although many women become headache-free during the last two trimesters, 25% have no change in their migraine.82, 86 MM typically improves with pregnancy.82, 86 Hormonal replacement with estrogens can exacerbate migraine, and oral contraceptives (OCs) can change its character and frequency.10, 46 Migraine prevalence decreases with advancing age but may regress or worsen at the menopause.64 Changes in the headache pattern with OC use and during menarche, menstruation, pregnancy, and menopause are related to changes in estrogen levels. These phenomena suggest a relationship between migraine headaches and changes in sex hormone levels.52 This article discusses the endocrinology of the menstrual cycle and approaches to the therapy of hormone-related headaches, in particular headaches associated with the menstrual cycle, the menopause, and OC use.
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| Address reprint requests to Stephen D. Silberstein, MD, Jefferson Headache Center, Thomas Jefferson University Hospital, Gibbon Building, Suite #8130, 111 South 11th Street, Philadelphia, PA 19107. e-mail: Stephen.Silberstein@mail.tju.edu |
Vol 85 - N° 4
P. 1017-1035 - juillet 2001 Retour au numéro
Article précédent
- CLUSTER AND RELATED HEADACHES
- Lawrence C. Newman, Peter Goadsby, Richard B. Lipton
- PEDIATRIC HEADACHE
- Steven L. Linder, Paul Winner
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