Sex-Specific Pharmacotherapy for Migraine: A Narrative Review

Abstract

Migraine is a common neurological disorder characterized by recurrent headache episodes that accompany sensory-motor disturbances, such as higher sensitivity to touch and light, extremity heaviness or weakness, and speech or language disabilities. Worldwide, migraine is one of the top 10 causes of disability and hence poses a huge economic burden to society. On average, migraine occurs in 12% of population but its occurrence is sexually dimorphic, as it is two to three times more prevalent in women than in men. This female to male ratio of migraine prevalence is age-and sex hormone-dependent. Advancements in understanding migraine pathogenesis have also revealed an association with both genetics and epigenetics. The severity of migraine, in terms of its attack duration, headache intensity, frequency, and occurrence of migraineassociated symptoms, has generally been reported to be greater in women. Sex differences in migraine disability and comorbidities, such as psychiatric disorders, have also been noted in some population-based studies. However, research on sex-related differences in response to migraine treatments is relatively scarce. Although a general observation is that women consume more medication than men for migraine treatment, strategies for the use of abortive and preventive medications for migraine are generally similar in both sexes. This narrative review summarizes available findings on sexually distinct responses to abortive and prophylactic pharmacotherapy of migraine. Basic experimental data and clinical findings will be presented, and potential mechanisms underlying sex-based responses will be discussed to highlight the importance and value of sex-based treatment in migraine research and practice.

Clinical Manifestations of Overactive Bladder With Migraine as a Comorbidity: A Prospective Cross-Sectional Study

“…This ratio was found to be higher than the prevalence of migraine (5-21.8%) in the previous reports. [14][15][16][17] The comorbidity of both conditions was more frequently observed in our study in accordance with the literature. 10,18 In their study, Coyne et al investigated comorbid conditions in patients with and without LUTS symptoms, and they indicated that LUTS could be associated with a higher number of comorbid conditions that share common pathophysiological pathways.…”

“…In our study, we also found that the presence of migraine in OAB patients was 39.9%. This ratio is higher than the previously reported prevalence of migraine (5%–21.8%) [ 14 - 17 ]. The clustering of both conditions as comorbidities was disproportionately frequently observed in our study, in accordance with the literature [ 10 , 18 ].…”

Gender Specific Differences in Disease Susceptibility: The Role of Epigenetics

“…Particularly, in the case of stroke, dementia, and depression, caffeine consumption seems to be more protective in women than in men, and has a more protective effect in men in the case of Parkinson's disease [70]. There is also evidence of gender differences in the responses to treatments for several human pathologies, including cancer, cardiovascular disease, chronic pulmonary disease, stroke, diabetes, and migraine [20,[71][72][73][74][75][76]. For example, in treatment of small cell-lung cancer, being female is generally regarded as a positive prognostic factor, although females are more prone to an increased toxicity from chemotherapy respect to males [77].…”

A Link Between Migraine and Prolactin: the Way Forward

“…This can be investigated when accumulating data are becoming available following administration of those new drugs. Considering pharmacokinetic parameters and differences between females and males, both in laboratory animals and humans, future basic and clinical studies may unfold some characteristics of sex-related responses [ 5 , 72 ].…”

“…Women between the ages of 30 and 45 years, in particular, are affected, with as many as 25–30% of the general female population affected [ 2 ] compared with 8% of men affected, and therefore, the burden of this disorder is higher in women [ 3 ]. There are several interpretations for the sexual dimorphic etiology of migraine [ 4 ], and hence, proposals for sex-based treatments of migraine have emerged [ 5 ]. Observations of changes in women with migraine during menstrual cycles, pregnancy, and menopause have suggested that a hormonal component contributes to the sexual dimorphic pathophysiology of migraine [ 6 ].…”