Jealousy in women with migraine: a cross-sectional case-control study

DOI: https://doi.org/10.1186/s10194- 020- 01114- 5

Abstract-Summary Estrogen influences susceptibility to migraine attacks and it has been suggested to affect jealousy in romantic relationships in women.

Jealousy levels and hormonal status were determined based on a cross-sectional,

web-based, questionnaire study among female migraine patients and controls.

Participants with a serious and intimate monogamous relationship were included (n = 498) and divided into the following subgroups: menstrual migraine (n = 167), non-menstrual migraine (n = 103), postmenopausal migraine (n = 117), and pre- menopausal (n = 57) and postmenopausal (n = 54) controls.

The primary outcome was the difference in mean jealousy levels between patients

with menstrual migraine, non-menstrual migraine and premenopausal controls.

The difference in jealousy levels between postmenopausal migraine patients and

controls was assessed.

Jealousy levels were higher in menstrual migraine patients compared to controls (mean difference ± SE: 3.87 ± 1.09, p = 0.001), and non-menstrual migraine patients compared to controls (4.98 ± 1.18, p < 0.001).

No difference in jealousy was found between postmenopausal migraine patients

and controls (− 0.32 ± 1.24, p = 0.798). Background Sex hormones have a major influence on migraine, appearing from a three times higher migraine prevalence in premenopausal women compared to men, an increase in attack frequency during menopausal transition, and a postmenopausal decrease of symptoms [301–303].

Although the exact pathophysiological underlying mechanism remains unclear, previous research has suggested that fluctuations in estrogen levels, possibly the rate of decrease in estrogen, may affect the susceptibility to migraine attacks in women and/or higher estrogen levels may be implicated in both sexes [302, 304–307].

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In the fertile phase, when estrogen levels are high, women tend to report higher

jealousy levels compared to other times of the menstrual cycle [308].

We hypothesized that women with migraine, especially those fulfilling the crite- ria of MM, would have higher jealousy levels compared to women with non- menstrual migraine (non-MM) and premenopausal controls due to a corresponding provoking effect of estrogen in migraine and jealousy.

Methods Participants received a web-based questionnaire consisting of questions concerning relationship duration, jealousy feelings and thoughts, menstrual cycle status and exogenous sex hormone use.

The covariates age, relationship duration and hormonal status were chosen

a- priori based on previous studies.

Although the effect of relationship duration on jealousy levels is inconsistent in previous studies, this covariate was reasoned to be important, and therefore, was included in this study [309, 310].

Age, relationship duration and hormonal status were included as covariates. In a secondary analysis, we compared the mean total jealousy levels of post- menopausal migraine patients and controls using a generalized linear model, adjust- ing for age and relationship duration.

The same statistical model was used to compare mean jealousy levels between women using COC and women with a regular menstrual cycle, controlling for age, relationship duration and migraine status.

Results A pairwise comparison with Bonferroni correction revealed that the mean jealousy levels were higher in patients with MM compared to controls (mean difference ± SE: 3.87 ± 1.09, p = 0.001), and in non-MM patients compared to controls (4.98 ± 1.18, p < 0.001).

A pairwise comparison with Bonferroni correction revealed that both MM and non-MM groups reported higher levels compared to the premenopausal control group for the reactive jealousy sub-type (mean difference  ±  SE: 1.89  ±  0.64, p = 0.010 and 1.97 ± 0.70, p = 0.014, respectively).

Both MM and non-MM groups reported higher anxious jealousy levels com- pared to premenopausal controls (1.24 ± 0.49, p = 0.035 and 1.83 ± 0.53, p = 0.002, respectively).

Non-MM patients reported higher mean preventive jealousy scores compared to

premenopausal controls (1.18 ± 0.38, p = 0.005).

Discussion Premenopausal women with migraine in a relationship have significantly higher jealousy scores than controls in this study.

Previous research showed estrogen levels to be higher in women with MM com- pared to controls during most phases of the menstrual cycle, and with only small differences between MM and non-MM patients [305, 306].

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The effect of a disabling chronic disease on the quality of life might explain the higher jealousy response within romantic relationships in female migraine patients. Although postmenopausal women with migraine are limited in social activities, their jealousy response is comparable to that of postmenopausal controls, suggest- ing that impaired social functioning only partially contributes to the difference in jealousy between younger migraine patients and controls.

Women using combined oral contraceptives reported higher jealousy compared to non-using women with a regular menstrual cycle, which is congruent with previ- ous studies [308, 309].

In a prior study, higher jealousy levels were found in the fertile phase compared

to the non-fertile phase of the menstrual cycle.

Conclusions Future research is needed on establishing the role of estrogen in women with migraine as this may provide important treatment options for this incapacitating disorder.

Acknowledgement A machine generated summary based on the work of van Casteren, Daphne S.; van Willigenburg, Florine A.  C.; MaassenVanDenBrink, Antoinette; Terwindt, Gisela M. 2020 in The Journal of Headache and Pain.

Effect of Migraine Headache on Productivity of Patients According to Migraine Disability Assessment Score: A Cross-Sectional Study