Ovarian Hormones and Migraine Headache: Understanding Mechanisms and Pathogenesis--Part 2

Vincent T. Martin, MD; Michael Behbehani, PhD

Disclosures

Headache. 2006;46(3):365-386. 

In This Article

Nonmenstrual Migraine

The effect of ovarian hormones on attacks of nonmenstrual migraine is less clear. Studies have not convincingly shown an increased frequency of migraine headache during the mid-cycle or ovulatory time period of the menstrual cycle. Two past studies[14,15] have attempted to identify the day of ovulation by counting back 14 days from the onset of menstruation from the next cycle. They did not find an increased incidence of migraine headache at that time when compared with the rest of the menstrual cycle, but they may not have accurately identified the ovulatory time period, since no independent hormonal monitoring was performed.

Studies[16,50] suggest that the mid-luteal intervals of the menstrual cycle might represent times of less frequent, severe, and disabling migraine headache. Martin et al[16] reported that the headache index was highest during the early follicular, intermediate during mid-cycle, and lowest during mid-luteal intervals. There was a trend toward lower headache outcome measures in mid-luteal intervals when compared with all other outcome measures (P< .04). Beckham et al[50] also reported that the headache index was lowest during luteal time intervals in 14 female migraineurs (11 had menstrual migraine). These data could suggest that the hormonal milieu of the mid-luteal time period (eg, high progesterone/high estrogen levels) could play a preventative role for migraine headache, possibly secondary to agonism of neuroinhibitory GABA-A receptors by progesterone and/or its metabolites within trigeminal pain pathways.[51,52]

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