Current Pain and Headache Reports

, Volume 5, Issue 5, pp 449–453 | Cite as

Estrogen and tension-type headache

  • Dawn A. Marcus


The vast majority of people experience tension-type headache during their lifetimes. Boys experience tension-type headache slightly more than girls during preadolescent years. During adolescence and adult years, tension-type headache occurs more commonly in females. Tension-type headache changes in women occur in relation to gynecologic changes, including menses, pregnancy, and menopause. These changes are related to estrogen fluctuations. Estrogen fluctuations cause changes in neurochemicals important for pain signal transmission, including serotonin, gammaaminobutyric acid, and enkephalins.


Estrogen Migraine Sumatriptan Chronic Daily Headache Chronic Headache 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Marcus DA: Identification of headache subjects at risk for psychological distress. Headache 2000, 40:373–376. Reports the important disability associated with frequent, mild headache, suggesting a greater importance should be given to diagnosis and treatment of tension-type headache.PubMedCrossRefGoogle Scholar
  2. 2.
    Rasmussen BK: Epidemiology of headache. Cephalalgia 1995, 15:45–68.PubMedGoogle Scholar
  3. 3.
    Rasmussen BK: Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 1993, 53:65–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Abu-Arefeh I, Russell G: Prevalence of headache and migraine in schoolchildren. BMJ 1994, 309:765–769.PubMedGoogle Scholar
  5. 5.
    Wober-Bingol C, Wober C, Wagner-Ennsgraber C, et al.: IHS criteria and gender: a study on migraine and tensiontype headache in children and adolescents. Cephalalgia 1996, 16:107–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Sillanpaa M: Changes in the prevalence of migraine and other headaches during the first seven school years. Headache 1983, 23:15–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Sillanpaa M, Piekkala P: Prevalence of migraine and other headaches in early puberty. Scand J Prim Health Care 1984, 2:27–32.PubMedGoogle Scholar
  8. 8.
    Barea LM, Tannhauser M, Rotta NT: An epidemiological study of headache among children and adolescents of southern Brazil. Cephalalgia 1996, 16:545–549.PubMedCrossRefGoogle Scholar
  9. 9.
    Schwartz BS, Stewart WF, Simon D, Lipton RB: Epidemiology of tension-type headache. JAMA 1998, 279:381–383.PubMedCrossRefGoogle Scholar
  10. 10.
    Rasmussen BK, Jensen R, Schroll M, Olesen J: Epidemiology of headache in a general population-a prevalence study. J Clin Epidemiol 1991, 44:1147–157.PubMedCrossRefGoogle Scholar
  11. 11.
    Rasmussen BK: Epidemiology of headache. Cephalalgia 1995, 15:45–68.PubMedGoogle Scholar
  12. 12.
    Scharff L, Turk DC, Marcus DA: Triggers of headache episodes and coping responses of headache diagnostic groups. Headache 1995, 35:397–403.PubMedCrossRefGoogle Scholar
  13. 13.
    Solbach P, Sargent J, Coyne L, et al.: Tension headache: a comparison of menstrual and nonmenstrual occurrences. Headache 1998, 28:108–10.CrossRefGoogle Scholar
  14. 14.
    Marcus DA, Scharff L, Turk D: Longitudinal prospective study of headache during pregnancy and postpartum. Headache 1999, 39:625–632.PubMedCrossRefGoogle Scholar
  15. 15.
    Martignoni E, Neri I, Granella F, et al.: Prevalence of postmenopausal headache: a prospective study. Cephalalgia 1991, 11(suppl):196–97.Google Scholar
  16. 16.
    MacGregor EA, White DS: Headache in a specialist menopause clinic. Cephalalgia 1997, 17:322.Google Scholar
  17. 17.
    Leidy LE, Canali C, Callahan WE: The medicalization of menopause: implications for recruitment of study participants. Menopause 2000, 7:193–99.PubMedCrossRefGoogle Scholar
  18. 18.
    Neri I, Granella F, Nappi R, et al.: Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas 1993, 17:31–37.PubMedCrossRefGoogle Scholar
  19. 19.
    Bartelink MV, van den Lisdonk E, van den Hoogen H, et al.: Migraine in family practice: prevalence and influence of sex hormonal status. Fam Med 1993, 25:331–336.PubMedGoogle Scholar
  20. 20.
    Marcus DA: Interrelationships of neurochemicals, estrogen, and recurring headache, Pain 1995, 62:129–39.PubMedCrossRefGoogle Scholar
  21. 21.
    Coyle DE, Selhorst CS, Behbehani MM: Intact female rats are more susceptible to the development of tactile allodynia than ovariectomized female rats following partial sciatic nerve ligation (PSNL). Neurosci Lett 1996, 203:37–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Hellstrom B, Lundberg U: Pain perception to the cold pressor test during the menstrual cycle in relation to estrogen levels and a comparison with men. Integr Physiol Behav Sci 2000, 35:132–41.PubMedGoogle Scholar
  23. 23.
    Amandusson A, Hermanson O, Blomqvist A: Colocalization of oestrogen receptor immunoreactivity and preproenkephalin mRNA expression to neurons I the superficial laminae of the spinal and medullary dorsal horn of rats. Eur J Neurosci 1996, 8:2440–2445.PubMedCrossRefGoogle Scholar
  24. 24.
    Amandusson A, Hallbeck M, Hallbeck AL, et al.: Estrogeninduced alterations of spinal cord enkephalin gene expression. Pain 1999, 83:243–248. This rodent study demonstrates an important direct interaction between estrogen and the pain modulatory system. Estrogen is able to alter spinal and trigeminal opioid levels by increasing release of enkephalin from spinal and trigeminal neurons.PubMedCrossRefGoogle Scholar
  25. 25.
    Joy KP, Tharakan B, Goos HJ: Distribution of gammaaminobutyric acid in catfish (Heteropneustes fossilis) forebrain in relation to season, ovariectomy and E2 replacement, and effects of GABA administration on plasma gonadotropin-II level. Comp Biochem Physiol A Mol Integr Physiol 1999, 123:369–376. Evaluates catfish brain neurotransmitter function in relation to estradiol. The inhibitory neurotransmitter GABA is elevated after exposure to estradiol.PubMedCrossRefGoogle Scholar
  26. 26.
    Lagrange AH, Ronnekleiv OK, Kelly MJ: The potency of mu-opioid hyperpolarization of hypothalamic arcuate neurons is rapidly attenuated by 17-beta-estradiol. J Neurosci 1994, 14:6196–6204.PubMedGoogle Scholar
  27. 27.
    LeResche L, Saunders K, Von Korff MR, et al.: Use of exogenous hormones and risk of temporomandibular disorders. Pain 1997, 6:153–60.CrossRefGoogle Scholar
  28. 28.
    Rolf LH, Wiele G, Brune GG: 5-hydroxytryptamine in platelets of patients with muscle contraction headache. Headache 1981, 21:10–1.PubMedCrossRefGoogle Scholar
  29. 29.
    Milovanovic DD, Majkic-Sing N, Mirkovic D: Plasma and urinary serotonin and 5-hyroxyindol-3-acetic acid in adults ith migraine and tension-type headache. Adv Exp Med Biol 1999, 467:191–97.PubMedGoogle Scholar
  30. 30.
    Marcus DA: Serotonin and its role in headache pathogenesis and treatment. Clin J Pain 1993, 9:159–67.PubMedCrossRefGoogle Scholar
  31. 31.
    Mathew RC, Ho BT, Kralik P, Claghorn JL: Biochemical basis for biofeedback treatment of migraine: a hypothesis. Headache 1979, 19:290–293.PubMedCrossRefGoogle Scholar
  32. 32.
    Srikiatkhachorn A, Tarasub N, Govitrapong P: Effect of chronic analgesic exposure on the central serotonin system: a possible mechanism of analgesic abuse headache. Headache 2000, 40:343–350. Confirms the hypothesis that chronic analgesic exposure results in analgesic overuse headache by reducing serotonin receptor sensitivity. Receptor downregulation occurs in conjunction with reduced clinical efficacy of acetaminophen.PubMedCrossRefGoogle Scholar
  33. 33.
    Marcus DA: Interrelationships of neurochemicals, estrogen, and recurring headache. Pain 1995, 62:129–39.PubMedCrossRefGoogle Scholar
  34. 34.
    Robbins LD: Sustained-release morphine sulfate (Kadian) for severe chronic daily headache. Headache 2000, 40:427.CrossRefGoogle Scholar
  35. 35.
    Fragoso YD, Carrazuna EJ: Low doses of gabapentin may be helpful in the management of chronic daily headache. Medscape Gen Med 2000, 6:E52.Google Scholar
  36. 36.
    Lipton RB, Stewart WF, Cady R, et al.: Sumatriptan for the range of headaches in migraine sufferers: results of the Spectrum study. Headache 2000, 40:783–791.PubMedCrossRefGoogle Scholar
  37. 37.
    Paulus W, Raubuchl O, Straube A, Schoenen J: Exteroceptive suppression of temporalis muscle activity in various types of headache. Headache 1992, 32:41–44.PubMedCrossRefGoogle Scholar
  38. 38.
    Schoenen J: Exteroceptive suppression of temporalis muscle activity: methodological and physiological aspects. Cephalalgia 1993, 13:3–0.PubMedCrossRefGoogle Scholar
  39. 39.
    Schoenen J, Bottin D, Sulon J, et al.: Exteroceptive silent period of temporalis muscle in menstrual headaches. Cephalalgia 1991, 11:87–91.PubMedCrossRefGoogle Scholar
  40. 40.
    Mathew NT, Kurman R, Perez F: Drug induces refractory headache-clinical features and management. Headache 1990, 30:634–638.PubMedCrossRefGoogle Scholar
  41. 41.
    Marcus DA, Scharff L, Turk DC: Nonpharmacologic management of headaches during pregnancy. Psychosom Med 1995, 57:527–533.PubMedGoogle Scholar
  42. 42.
    Scharff L, Marcus DA, Turk DC: Maintenance of effects in the nonmedical treatment of headaches during pregnancy. Headache 1996, 36:285–290.PubMedCrossRefGoogle Scholar
  43. 43.
    Olesen C, Steffensen FH, Sorensen HT, et al.: Pregnancy outcome following prescriptions for sumatriptan. Headache 2000, 40:20–24. These data, collected through the Danish registry, provide the first reported large-scale evaluation of triptan effects with pregnancy through national data collection. Previous reports have involved voluntary reporting through triptan registries. Pregnancy outcome is compared among nonheadache controls, migraineurs not using triptans, and migraineurs using triptans during pregnancy.PubMedCrossRefGoogle Scholar
  44. 44.
    Vestergaard P, Hermann AP, Gram J, et al.: Improving compliance with hormonal replacement therapy in primary osteoporosis prevention. Maturitas 1997, 15:137–45.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Dawn A. Marcus
    • 1
  1. 1.Pain Evaluation and Treatment InstitutePittsburghUSA

Personalised recommendations