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Review
. 2022 Apr 15;11(8):1355.
doi: 10.3390/cells11081355.

Role of Estrogens in Menstrual Migraine

Rossella E Nappi  1   2 , Lara Tiranini  2 , Simona Sacco  3 , Eleonora De Matteis  3 , Roberto De Icco  4   5 , Cristina Tassorelli  4   5
Affiliations
Review

Role of Estrogens in Menstrual Migraine

Rossella E Nappi et al. Cells. .

Abstract

Migraine is a major neurological disorder affecting one in nine adults worldwide with a significant impact on health care and socioeconomic systems. Migraine is more prevalent in women than in men, with 17% of all women meeting the diagnostic criteria for migraine. In women, the frequency of migraine attacks shows variations over the menstrual cycle and pregnancy, and the use of combined hormonal contraception (CHC) or hormone replacement therapy (HRT) can unveil or modify migraine disease. In the general population, 18-25% of female migraineurs display a menstrual association of their headache. Here we present an overview on the evidence supporting the role of reproductive hormones, in particular estrogens, in the pathophysiology of migraine. We also analyze the efficacy and safety of prescribing exogenous estrogens as a potential treatment for menstrual-related migraine. Finally, we point to controversial issues and future research areas in the field of reproductive hormones and migraine.

Keywords: calcitonin gene-related peptide; contraception; efficacy; estradiol; ethinylestradiol; gender; hormone replacement therapy; progesterone; regimen; reproductive hormones.

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Conflict of interest statement

R.E.N. had past financial relationships (lecturer, member of advisory boards and/or consultant) with Boehringer Ingelheim, Ely Lilly, Endoceutics, Gedeon Richter, HRA Pharma, Merck Sharpe & Dohme, Procter & Gamble Co., TEVA Women’s Health Inc. and Zambon SpA. At present, she has an ongoing relationship with Astellas, Bayer HealthCare AG, Exceltis, Fidia, Novo Nordisk, Organon & Co., Palatin Technologies, Pfizer Inc., Shionogi Limited and Theramex. S.S. had a financial relationship (lecturer or member of advisory board) with Abbott, Allergan, Novartis, Teva, and Eli Lilly. R.D.I. has received speaker honoraria for lecturing for Eli-Lilly and TEVA. C.T. received honoraria for consultancy on advisory boards for Allergan, ElectroCore, Eli Lilly, Novartis, and Teva and lecturing for Allergan, Eli Lilly, Novartis, and Teva. Her Institute received funding for clinical trials by Alder, Amgen, Eli Lilly, and Teva. She received grants from the European Commission, the Italian Ministry of Health, and the Italian Ministry of University. None of these companies are relevant to the present work. Other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic phases of the menstrual cycle (top panel); types of combined hormonal contraception (CHC) and other estrogen treatments evaluated in menstrual migraine (MM) prevention (middle panel); main treatment regimens of CHC (bottom panel). Created with BioRender.com (2022).
Figure 2
Figure 2
Summary of the main efficacy and safety recommendations for the use of hormonal treatments in menstrual migraine (MM) prevention. Created with BioRender.com (2022). Abbreviations: CHC: combined hormonal contraception, EE: ethinylestradiol, MRM: menstrually related migraine, PMM: pure menstrual migraine.
See this image and copyright information in PMC

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