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Defining the Relationship Between Ovarian Hormones
and Migraine Headache
Martin VT, Wernke S, Mandell K, et al.
Posted: December 2005  
Headache 2005;45:1190-1201

Objective:  (1) To determine whether the attack characteristics of migraine differ between different intervals of the menstrual cycle; (2) To ascertain whether the "rate of change", "magnitude of change", or "total burden" of urinary hormone metabolites correlates with headaches outcome measures during different intervals of the menstrual cycle.

Background:   The mechanisms through which migraines are influenced by ovarian hormones remain unclear. No previous studies until now have identified "hormonally defined" time intervals within the female menstrual cycle and compared headache outcome measures among these intervals in female migraineurs.

Methods:   Daily headache diary data were obtained from 21 female migraineurs during three native menstrual cycles. Daily urine samples were collected and later assayed for estrogen and progesterone metabolites. Seven 3-day time intervals were identified within each menstrual cycle based on urine hormone measurements. Primary (headache index) and secondary (disability index, headache severity, and headache frequency) outcome measures were compared between intervals using the mixed model approach. "Rates of change", "magnitude of change", and the "total burden" of ovarian hormones were estimated from urine hormone metabolites and correlated with headache outcome measures.

Conclusions:   Migraine headache is more severe, disabling, and frequent during the menstrual intervals of the female reproductive cycle than during mid-luteal or mid-cycle intervals. Progesterone metabolites may play a role in modulating migraine headaches during luteal intervals of the menstrual cycle.