New Theories in the pathogenesis of menstrual migraine

Abstract

Hormonal and nonhormonal factors play a role in the pathophysiology of menstrual migraine, but estrogen withdrawal appears to be the most potent of these factors. It is postulated that estrogen withdrawal directly enhances excitability of trigeminal afferents, modulates the synthesis of neuropeptides, activates/deactivates specific neurotransmitter systems, and influences the function of microglia. These changes could activate and/or sensitize the trigeminal system and increase the likelihood of migraine headache during perimenstrual time periods. Three new theories are advanced in this article to explain the pathophysiology of menstrual migraine. Only through an understanding of the mechanisms involved in menstrual migraine can we gain insight into the management of this severe and debilitating form of migraine headache.

Pure menstrual hemicrania continua: Does it exist? A case report

“…The trigeminal pain network includes the sensory system (e.g. trigeminal nerve, trigeminal nerve caudalis, thalamus and cortex), brainstem nuclei, autonomic nervous system, and meningeal artery (14). Activation of the brainstem has been demonstrated in both HC and migraine (15).…”

Management of Menstrual Migraine: A Review of Current Abortive and Prophylactic Therapies

“…When a similar study group was administered progesterone, the result was a delay in bleeding without a change in migraine pattern [10]. This led to the hypothesis that migraine could be triggered by estrogen withdrawal, a supposition that has been supported by multiple studies [6, 9, 11–14]. …”

Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine: Results of the American Migraine Prevalence and Prevention Study

“…A heavy flow of vaginal bleeding during menses has been associated with enhanced synthesis of uterine prostaglandins as compared to those with normal flow . The synthesis of prostaglandins and their release into the systemic circulation have been postulated to trigger attacks of menstrually related migraine . Another potential mechanism that might increase the frequency of menstrual related migraine is iron deficiency induced by heavy menstrual flow…”