Male and female sex hormones in primary headaches

DOI: https://doi.org/10.1186/s10194- 018- 0922- 7

Abstract-Summary The three primary headaches, tension-type headache, migraine and cluster head- ache, occur in both genders, but all seem to have a sex-specific prevalence.

These gender differences suggest that both male and female sex hormones could

have an influence on the course of primary headaches.

Search strings were composed using the terms LH, FSH, progesteron, estro- gen, DHEA, prolactin, testosterone, androgen, headach, migrain, “tension type” or cluster.

The role of other hormones as well as the importance of sex hormones in other

primary headaches is far less studied.

The available literature mainly covers the role of sex hormones in migraine

in women.

Detailed studies especially in the elderly of both sexes and in cluster headache and tension-type headache are warranted to fully elucidate the role of these hor- mones in all primary headaches.

Extended: The role of estrogen in CH and the reason for CH onset in these

women remain unclear.

The role of testosterone in cluster headache was further studied by Stillman and others in their investigation of laboratory findings of 7 male and 2 female patients with treatment refractory cluster headache.

Detailed studies especially in the elderly of both sexes, in CH, and TTH are war- ranted in order to clearly elucidate the role of sex hormones in not just migraine, but all primary headaches.

2.5 Hormones

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Introduction These gender differences suggest that both male and female sex hormones could have an influence on the course of primary headaches.

Within the group of primary headaches the role of sex hormones has been stud-

ied most profoundly in migraine.

The course of migraine throughout the lifespan of men appears relatively stable, further pointing to the unique role of female sex hormones in the migraine pheno- type [677].

We summarise relevant literature of the last 20 years covering the influence of

female and male sex hormones on primary headaches.

Search Strategy and Selection Criteria In light of the large amount of published work on the topic and considering the evolution of the diagnostic criteria over time, the first search was conducted respect- ing a timeframe of 20 years, covering articles published after January 1st 1997.

Exclusion criteria included non-availability of abstract, animal studies, and arti-

cles in any language other than English.

Original studies, published in full, constitute the core of this review. Any relevant publications cited in the eligible articles were also included.

Results In one retrospective study with 85 female patients with menstrual migraine, 35.3% reported migraine headache onset by the end of menstruation, which is days after the estrogen drop.

Like migraine, TTH occurs more often in women than in men and some studies have suggested an increase during hormonal changes such as menses or pregnancy. The amount of estrogen withdrawal episodes is correlated to headache attack

frequency in women with menstrual migraine in “early” perimenopause.

MacGregor and others showed that transdermal patches with estrogen can be effective in decreasing migraine attack frequency in perimenopausal and postmeno- pausal women, supposedly more effectively than oral contraceptives [678].

Only the relationship between migraine and estrogen has been extensively stud- ied in older women, possibly because of the high prevalence of migraine and its sensitivity to hormonal fluctuations.

Discussion Reviewing recent literature, it becomes evident that most experimental data on the causal relationship between sex hormones and primary headaches covers women suffering from migraine in the reproductive or perimenopausal phase of their life.

There is currently no evidence to support the superiority of hormonal therapy

over non-hormonal pharmacological treatment strategies.

When using hormonal therapies in migraine patients, whether it is as a contra- ceptive or as a treatment, potential cardiovascular risks should be considered when deciding which type of hormones to use.

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2 Mechanisms

For the other primary headaches and more so ever for headaches in male patients,

the role of sex hormones is vague.

It seems plausible that trying to uncover the effects of sex hormones on the other

primary headaches may offer new insights in pathophysiological mechanisms.

Conclusion All three primary headaches, migraine, TTH, and CH, occur in both genders, but with a sex-specific prevalence.

These findings suggest that both male and female sex hormones could play an

important role in the pathophysiology of primary headaches.

Detailed studies especially in the elderly of both sexes, in CH, and TTH are war- ranted in order to clearly elucidate the role of sex hormones in not just migraine, but all primary headaches.

Acknowledgement A machine generated summary based on the work of Delaruelle, Zoë; Ivanova, Tatiana A.; Khan, Sabrina; Negro, Andrea; Ornello, Raffaele; Raffaelli, Bianca; Terrin, Alberto; Mitsikostas, Dimos D.; Reuter, Uwe; 2018  in The Journal of Headache and Pain.

Women and Migraine: the Role of Hormones