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. 2021 Mar;41(3):417-421.
doi: 10.1177/0333102420966977. Epub 2020 Oct 21.

Pain perception in women with menstrually-related migraine

Katie M Linstra  1   2 , Khatera Ibrahimi  1 , Daphne S van Casteren  1   2 , Marieke Jh Wermer  2 , Gisela M Terwindt  2 , Antoinette MaassenVanDenBrink  1
Affiliations

Pain perception in women with menstrually-related migraine

Katie M Linstra et al. Cephalalgia. 2021 Mar.

Abstract

Background: Cyclic hormonal fluctuations influence migraine incidence and severity. Previously, we described reduced menstrual cyclicity in estradiol levels and dermal blood flow reaction to capsaicin in female migraineurs. It is unclear whether pain perception in women with migraine is influenced by the menstrual cycle.

Methods: Women with menstrually-related migraine (n = 14), healthy age-matched controls (n = 10) and postmenopausal women (n = 15) were asked to grade trigeminal and non-trigeminal painful stimuli on a numeric pain rating scale on menstrual cycle day 19-21 (mid-luteal) and day 1-2 (early follicular).

Results: In women with menstrually-related migraine, trigeminal pain remained low throughout the cycle. Controls showed increased trigeminal pain during the mid-luteal phase compared to the early follicular phase. Changes throughout the cycle were significantly different between women with MRM and controls.

Conclusion: The compromised menstrual cyclicity of pain perception in women with menstrually-related migraine parallels our earlier findings on estradiol levels and dermal blood flow.

Keywords: Headache; estrogen; menstrual cycle; sex hormones.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KML was supported by grant of the Dutch Heart Foundation (grant number 2013T083); KI received support for conference visits from Menarini and MSD; DSVC reports no disclosures.

MJHW was supported by a ZonMw/NWO VIDI (grant number 9171733); GMT was supported by a ZonMw/NWO VIDI (grant number 91711319), reports grants or consultancy support from Novartis, Lilly, Teva, and independent support from NWO, ZonMw, NIH, European Community, Dutch Heart Foundation, and Dutch Brain Foundation.

AMVDB was supported by a ZonMw/NWO VIDI (grant number 917113349), has received fees and grant support from the following organizations over the most recent 5 year period: Amgen/Novartis, Lilly/CoLucid, Teva and ATI.

Figures

Figure 1.
Figure 1.
Comparison of pain stimuli. Pain scores in numeric pain rating scale (0–10 NPRS) for trigeminal ((a), left panel) and non-trigeminal ((b), right panel) pain stimuli: Capsaicin 0.06 mg/ml, capsaicin 6.0 mg/ml, electrical stimulation to the forehead (ES head), high pressures applied with sphygmomanometer (HP), venipuncture (VP) and electrical stimulation to the neck (ES neck). Controls (dark blue) and patients with MRM (red) and postmenopausal women (light blue). *Significant difference in NPRS between painful stimuli (p < 0.05).
Figure 2.
Figure 2.
Comparison of pain between groups and visits. Pain scores in numeric pain rating scale (0–10 NPRS) for trigeminal ((a), left panel) and non-trigeminal ((b), right panel). For controls (dark blue ■) and patients with MRM (red ●): Visit 1 = days 19–21 of the menstrual cycle and visit 2 = days 1–2 of menstruation. For postmenopausal women (light blue ▲): Visit 1 and visit 2 planned randomly with 7–10 days in between. *Significant difference in NPRS between visit 1 and visit 2 for healthy controls (p = 0.003).
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