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Abstract
Objective: To compare daily sex hormone levels and rates of change between women with history of migraine and controls.
Methods: History of migraine, daily headache diaries, and daily hormone data were collected in ovulatory cycles of pre- and early perimenopausal women in the Study of Women's Health Across the Nation. Peak hormone levels, average daily levels, and within-woman day-to-day rates of decline over the 5 days following each hormone peak were calculated in ovulatory cycles for conjugated urinary estrogens (E1c), pregnanediol-3-glucuronide, luteinizing hormone, and follicle-stimulating hormone. Comparisons were made between migraineurs and controls using 2-sample t tests on the log scale with results reported as geometric means.
Results: The sample included 114 women with history of migraine and 223 controls. Analyses of within-woman rates of decline showed that E1c decline over the 2 days following the luteal peak was greater in migraineurs for both absolute rate of decline (33.8 [95% confidence interval 28.0–40.8] pg/mgCr vs 23.1 [95% confidence interval 20.1–26.6] pg/mgCr, p = 0.002) and percent change (40% vs 30%, p < 0.001). There was no significant difference between migraineurs and controls in absolute peak or daily E1c, pregnanediol-3-glucuronide, luteinizing hormone, and follicle-stimulating hormone levels. Secondary analyses demonstrated that, among migraineurs, the rate of E1c decline did not differ according to whether a headache occurred during the cycle studied.
Conclusions: Migraineurs are characterized by faster late luteal phase E1c decline compared to controls. The timing and rate of estrogen withdrawal before menses may be a marker of neuroendocrine vulnerability in women with migraine.
GLOSSARY
- BMI=
- body mass index;
- DHS=
- Daily Hormone Study;
- E1c=
- conjugated urinary estrogens;
- ELA=
- evidence of luteal activity;
- FSH=
- follicle-stimulating hormone;
- ICHD=
- International Classification of Headache Disorders;
- LH=
- luteinizing hormone;
- MHx=
- women with history of migraine;
- Pdg=
- pregnanediol-3-glucuronide;
- SWAN=
- Study of Women's Health Across the Nation
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received September 9, 2015.
- Accepted in final form March 17, 2016.
- © 2016 American Academy of Neurology
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