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Neurological Sciences

, Volume 39, Supplement 1, pp 11–20 | Cite as

Estrogen, migraine, and vascular risk

  • Gianni AllaisEmail author
  • Giulia Chiarle
  • Silvia Sinigaglia
  • Gisella Airola
  • Paola Schiapparelli
  • Chiara Benedetto
Review Article

Abstract

Migraine has a predilection for female sex and the course of symptoms is influenced by life stage (presence of menstrual cycle, pregnancy, puerperium, menopause) and use of hormone therapy, such as hormonal contraception and hormone replacement therapy. Hormonal changes figure among common migraine triggers, especially sudden estrogen drop. Moreover, estrogens can modulate neuronal excitability, through serotonin, norepinephrine, dopamine, and endorphin regulation, and they interact with the vascular endothelium of the brain. The risk of vascular disease, and ischemic stroke in particular, is increased in women with migraine with aura (MA), but the link is unclear. One hypothesis posits for a causal association: migraine may cause clinical or subclinical brain lesions following repeated episodes of cortical spreading depression (CSD) and a second hypothesis that may explain the association between migraine and vascular diseases is the presence of common risk factors and comorbidities. Estrogens can play a differential role depending on their action on healthy or damaged endothelium, their endogenous or exogenous origin, and the duration of their treatment. Moreover, platelet activity is increased in migraineurs women, and it is further stimulated by estrogens.

This review article describes the course of migraine during various life stages, with a special focus on its hormonal pathogenesis and the associated risk of vascular diseases.

Keywords

Estrogens Ischemic stroke Hormone therapies Migraine with aura Migraine without aura 

Abbreviations

CSD

Cortical spreading depression

EE

Ethinylestradiol

FR

Framingham risk

HS

Hemorrhagic stroke

HC

Hormonal contraception

HFI

Hormone-free interval

HRT

Hormone replacement therapy

ICHD

International classification of headache disorders

IS

Ischemic stroke

MEC

Medical eligibility criteria

MA

Migraine with aura

MO

Migraine without aura

MM

Menstrual migraine

MRM

Menstrually related migraine

PMW

Perimenstrual window

PHS

Physician’s health study

PG

Prostaglandins

POP

Progestogen-only pill

PMM

Pure menstrual migraine

NO

Nitric oxide

VD

Vascular disease

WHS

Women health study

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

This article does not contain any study with human subjects performed by any of the authors.

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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Gianni Allais
    • 1
    Email author
  • Giulia Chiarle
    • 1
  • Silvia Sinigaglia
    • 1
  • Gisella Airola
    • 1
  • Paola Schiapparelli
    • 1
  • Chiara Benedetto
    • 1
  1. 1.Women’s Headache Center, Department of Surgical SciencesUniversity of TurinTurinItaly

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