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Yeh PK, An YC, Hung KS, Yang FC. Influences of Genetic and Environmental Factors on Chronic Migraine: A Narrative Review. Curr Pain Headache Rep 2024; 28:169-180. [PMID: 38363449 DOI: 10.1007/s11916-024-01228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW In this narrative review, we aim to summarize recent insights into the complex interplay between environmental and genetic factors affecting the etiology, development, and progression of chronic migraine (CM). RECENT FINDINGS Environmental factors such as stress, sleep dysfunction, fasting, hormonal changes, weather patterns, dietary compounds, and sensory stimuli are critical triggers that can contribute to the evolution of episodic migraine into CM. These triggers are particularly influential in genetically predisposed individuals. Concurrently, genome-wide association studies (GWAS) have revealed over 100 genetic loci linked to migraine, emphasizing a significant genetic basis for migraine susceptibility. In CM, environmental and genetic factors are of equal importance and contribute to the pathophysiology of the condition. Understanding the bidirectional interactions between these elements is crucial for advancing therapeutic approaches and preventive strategies. This balanced perspective encourages continued research into the complex gene-environment nexus to improve our understanding and management of CM.
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Affiliation(s)
- Po-Kuan Yeh
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Section 2, Cheng-Kung Road, Neihu 114, No. 325, Taipei, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Beitou Branch, Taipei, Taiwan
| | - Yu-Chin An
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Sheng Hung
- Center for Precision Medicine and Genomics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Section 2, Cheng-Kung Road, Neihu 114, No. 325, Taipei, Taiwan.
- Center for Precision Medicine and Genomics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Godley F, Meitzen J, Nahman-Averbuch H, O'Neal MA, Yeomans D, Santoro N, Riggins N, Edvinsson L. How Sex Hormones Affect Migraine: An Interdisciplinary Preclinical Research Panel Review. J Pers Med 2024; 14:184. [PMID: 38392617 PMCID: PMC10889915 DOI: 10.3390/jpm14020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Sex hormones and migraine are closely interlinked. Women report higher levels of migraine symptoms during periods of sex hormone fluctuation, particularly during puberty, pregnancy, and perimenopause. Ovarian steroids, such as estrogen and progesterone, exert complex effects on the peripheral and central nervous systems, including pain, a variety of special sensory and autonomic functions, and affective processing. A panel of basic scientists, when challenged to explain what was known about how sex hormones affect the nervous system, focused on two hormones: estrogen and oxytocin. Notably, other hormones, such as progesterone, testosterone, and vasopressin, are less well studied but are also highlighted in this review. When discussing what new therapeutic agent might be an alternative to hormone therapy and menopause replacement therapy for migraine treatment, the panel pointed to oxytocin delivered as a nasal spray. Overall, the conclusion was that progress in the preclinical study of hormones on the nervous system has been challenging and slow, that there remain substantial gaps in our understanding of the complex roles sex hormones play in migraine, and that opportunities remain for improved or novel therapeutic agents. Manipulation of sex hormones, perhaps through biochemical modifications where its positive effects are selected for and side effects are minimized, remains a theoretical goal, one that might have an impact on migraine disease and other symptoms of menopause. This review is a call to action for increased interest and funding for preclinical research on sex hormones, their metabolites, and their receptors. Interdisciplinary research, perhaps facilitated by a collaborative communication network or panel, is a possible strategy to achieve this goal.
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Affiliation(s)
- Frederick Godley
- Association of Migraine Disorders, P.O. Box 870, North Kingstown, RI 02852, USA
| | - John Meitzen
- Department of Biological Sciences, NC State University, Raleigh, NC 27695, USA
| | - Hadas Nahman-Averbuch
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - David Yeomans
- Department of Anesthesia, Pain and Perioperative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nina Riggins
- Brain Performance Center and Research Institute, San Diego, CA 92122, USA
| | - Lars Edvinsson
- Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University Hospital, 22185 Lund, Sweden
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Al-Qahtani Z, Narapureddy BR, Reddy LKV, Asiri HYM, Alsulami AAH, Hassan NKA, Shawkhan RA, Hamood NA, Almahdi HAM, Al Qasim YY, Al Majbar YAM, Swadi AAA, Asiri AHH, Almaker BAA. Study to Determine the Prevalence of Menstrual Migraine in Reproductive-Age Women in Saudi Arabia. Healthcare (Basel) 2024; 12:317. [PMID: 38338202 PMCID: PMC10855712 DOI: 10.3390/healthcare12030317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Migraine is a common health condition in both men and women. Premenstrual syndrome (PMS) affects many women during their menstrual cycle, with around 50-60% of women with migraine attacks experiencing menstrual headaches. Most have mild symptoms, but 5-8% suffer from moderate to severe symptoms, causing distress and functional issues. Pure menstrual migraine (PMM) occurs in about 50% of women with migraine, and it can be debilitating in terms of frequency and severity. This information is crucial for Saudi Arabian medical professionals to provide better care and support, improving the quality of life for women with PMS and menstrual migraine (MM) attacks. OBJECTIVES To estimate the prevalence of MM in women, to evaluate the severity and frequency of MM in women with PMS, and to identify potential risk factors aggravating MM in women with PMS in Saudi Arabia. METHODOLOGY A cross-sectional community-based study was conducted on reproductive-aged (18-50 years) women who had regular menstrual cycles and were diagnosed with PMS, using a self-administered questionnaire between December 2022 to May 2023 in Saudi Arabia. RESULTS Out of the 2130 female participants, 397 (18.6%) had migraine. Among these 397 migraine sufferers, 230 (57.9%) experienced MM, while 167 (42.1%) had non-MM. In reproductive women in general, MM occurred in 10.7% of cases, while non-MM was observed in 7.8%. There is a correlation between increasing BMI and an increased incidence of MM. About one-third of the participants experienced moderate disability due to migraine attacks, with 134 (33.8%) individuals affected. Additionally, most MM sufferers missed at least 3 days of work in the last 3 months due to their condition. CONCLUSIONS Migraine attacks occurring during the menstrual cycle impair the ability to engage in social, physical, household, and academic activities, often hindering the fulfillment of professional commitments. To gain a deeper understanding of menstrual and non-menstrual migraine attacks, it is essential to conduct extensive prospective studies aimed at developing effective management strategies.
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Affiliation(s)
- Zainah Al-Qahtani
- Neurology Section, Internal Medicine Department, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Bayapa Reddy Narapureddy
- Department of Public Health, College of Applied Medical Sciences, Khamis Mushayt, King Khalid University, Abha 61421, Saudi Arabia
| | | | - Hassan Yahya M. Asiri
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Ahmed Abdullah H. Alsulami
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Nawaf Khalid Ahmed Hassan
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Rammas Abdullah Shawkhan
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Nouf Abdulraheem Hamood
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Hussein Ahmed M. Almahdi
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Yousef Yahya Al Qasim
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Yahya Ayed Mohammed Al Majbar
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Abdullah Ali A. Swadi
- College of Medicine, King Khaled University, Abha 61421, Saudi Arabia; (H.Y.M.A.); (A.A.H.A.); (N.K.A.H.); (R.A.S.); (N.A.H.); (H.A.M.A.); (Y.Y.A.Q.); (Y.A.M.A.M.); (A.A.A.S.)
| | - Abdulbari Hadi H. Asiri
- College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (A.H.H.A.); (B.A.A.A.)
| | - Bassam Ahmed A. Almaker
- College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (A.H.H.A.); (B.A.A.A.)
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Lackovic M, Jankovic M, Mihajlovic S, Milovanovic Z, Nikolic D. Exploring the Connection between Migraines and Pregnancy: The Impact of Physical Activity on Symptom Management. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:49. [PMID: 38256310 PMCID: PMC10820455 DOI: 10.3390/medicina60010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024]
Abstract
Migraine is a prevalent neurological disorder that significantly impacts the quality of life for affected individuals. The pathogenesis behind migraines is not yet fully understood, but hormonal changes, especially fluctuations in, estrogen and progesterone levels, have a significant role in the susceptibility of women to migraines. Pregnancy introduces a unique set of challenges for women who experience migraines, as they must navigate the complexities of managing their condition while safeguarding the health of both them and their unborn child. Pharmacological options for treating migraines during pregnancy are limited, and, therefore, there is a growing interest in exploring alternative approaches to migraine symptom relief and management. Physical activity during pregnancy provides a range of benefits, and it has gained attention as a potentially valuable tool for alleviating migraine symptoms in pregnant patients. This review explores the intricate relationship between migraines and pregnancy, emphasizing how physical activity and other alternative approaches may influence the frequency, severity, and overall experience of migraines during pregnancy. Through collaboration with healthcare providers and the adoption of personalized management strategies, women can strike a balance that supports both their own well-being and the healthy development of their unborn child. By examining existing research and emerging insights, we aim to provide a comprehensive understanding of the potential benefits and considerations of incorporating physical activity and other treatment options into migraine management strategies for pregnant women. Further research is needed to elucidate the specific mechanisms linking migraines, pregnancy, and physical activity, enabling the development of more targeted interventions and guidelines.
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Affiliation(s)
- Milan Lackovic
- Department of Obstetrics and Gynecology, University Hospital “Dragisa Misovic”, Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.); (S.M.)
| | - Milena Jankovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (Z.M.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Sladjana Mihajlovic
- Department of Obstetrics and Gynecology, University Hospital “Dragisa Misovic”, Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.); (S.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (Z.M.)
| | - Zagorka Milovanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (Z.M.)
- Clinic for Gynecology and Obstetrics “Narodni Front”, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (Z.M.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
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Wang X, Na W, Yang Y, Zhang W, Zhao J, Zhang T, Zhou Y, Liu H, Zhao D, Yu S. Should migraine without aura be further divided? A study of 1444 female patients with migraine without aura. J Headache Pain 2023; 24:20. [PMID: 36859169 PMCID: PMC9976374 DOI: 10.1186/s10194-023-01540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
To explore the possibility of further dividing migraine without aura (MWA), 1444 female patients fulfilled the criterion were recruited, and grouped basing on the association of MWA onset with menarche and childbirth (group J1, onset before menarche; group J2, onset between menarche and childbirth; group J3, onset after childbirth). By comparing migraine (side, location, aggravated by routine physical activity, NRS score, frequency, accompanying symptoms, with premonitory symptom (PS) and trigger, sum of PS and trigger) and migraine-related factors [chronic daily headache, medicine overused headache, body mass index (BMI), education level, exercise status, sleep status, consumption of tea/coffee/alcohol, patient health questionnaire-9 (PHQ-9) score and generalized anxiety disorder-7, (GAD-7) score)] among groups, it was found that the J1 group and the J2 group presented more typical migraine features than the J3 group; 2) the J3 group was more prone to emotion and sleep disorders, weight management issues, frequent migraine attacks and medication overuse. This study provided a basis for further dividing MWA. Genetic research should be conducted and treatment should be prescribed accordingly because the underlying pathogenesis may be different.
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Affiliation(s)
- Xiaolin Wang
- grid.414252.40000 0004 1761 8894Department of Neurology, The First Medical Center, The Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Weinan Na
- grid.414252.40000 0004 1761 8894Department of Neurology, The First Medical Center, The Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Ying Yang
- grid.414252.40000 0004 1761 8894Department of Neurology, The First Medical Center, The Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Wenwen Zhang
- grid.414252.40000 0004 1761 8894Department of Neurology, The First Medical Center, The Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Junxia Zhao
- grid.414252.40000 0004 1761 8894Department of Neurology, The First Medical Center, The Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Tingting Zhang
- grid.414252.40000 0004 1761 8894Department of Neurology, The First Medical Center, The Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuanji Zhou
- grid.414252.40000 0004 1761 8894Department of Neurology, The First Medical Center, The Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Hua Liu
- grid.414252.40000 0004 1761 8894Department of Neurology, The First Medical Center, The Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Dong Zhao
- Department of Neurology, The First Medical Center, The Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
| | - Shengyuan Yu
- Department of Neurology, The First Medical Center, The Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
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Rossi MF, Tumminello A, Marconi M, Gualano MR, Santoro PE, Malorni W, Moscato U. Sex and gender differences in migraines: a narrative review. Neurol Sci 2022; 43:5729-5734. [PMID: 35676560 PMCID: PMC9176156 DOI: 10.1007/s10072-022-06178-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
Introduction Gender medicine is a new medical approach aimed at the study of the differences between women and men in terms of prevention, diagnosis, and the outcome of all diseases. Migraines are among these. They represent the most common neurological illness; they are most prevalent in adults between 20 and 50 years of age and are three to four times more frequent in woman than in men. Affecting people in working age, migraines are a problem that strongly impacts the psychophysical health and productivity of workers, regardless of the specific job task they have. Methods A narrative review was performed, searching for the most relevant articles describing gender differences in people suffering from migraines, and particularly in workers. Results Migraine global prevalence is 20.7% in women and 9.7% in men whereas prevalence in Italy is 32.9% for women and only 13.0% for men. This difference is partly explained by hormonal differences, as well as by differences in brain structure, genetic polymorphisms and neuronal pathways. Sex differences may also play a role in the progression from episodic to chronic migraine. In workers, migraines are mostly associated with strenuous physical work in men, whilst migraines triggered by night shifts, lack of sleep, or irregular sleep patterns are more common in women. Conclusions To this day, the reasons of sex/gender disparity for migraine are still obscure. However, migraines, chronic migraine in particular, have a negative impact on the lives of all individuals affected by this disease, but particularly in women in which family cares and working activity are often superimposed. Migraine prevention strategies should be planned in workers through the occupational health physician.
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Affiliation(s)
- Maria Francesca Rossi
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Antonio Tumminello
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Matteo Marconi
- Center for Gender-Specific Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | - Maria Rosaria Gualano
- Department of Public Health Sciences and Paediatrics, University of Torino, 10124, Torino, Italy
| | - Paolo Emilio Santoro
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Health Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Walter Malorni
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
- Gemelli Woman Health Center for Digital Health and Personalized Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Umberto Moscato
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Health Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
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Tsai CK, Tsai CL, Lin GY, Yang FC, Wang SJ. Sex Differences in Chronic Migraine: Focusing on Clinical Features, Pathophysiology, and Treatments. Curr Pain Headache Rep 2022; 26:347-355. [PMID: 35218478 DOI: 10.1007/s11916-022-01034-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This review provides an update on sex differences in chronic migraine (CM), with a focus on clinical characteristics, pathophysiology, and treatments. RECENT FINDINGS Approximately 6.8-7.8% of all migraineurs have CM, with an estimated prevalence of 1.4-2.2% in the general population. The economic burden caused by CM, including medical costs and lost working ability, is threefold higher than that caused by episodic migraine (EM). Notably, the prevalence of migraine is affected by age and sex. Female migraineurs with CM experience higher levels of headache-related disability, including longer headache duration, higher frequency of attacks, and more severely impacted efficiency at work. Sex hormones, including estrogen, testosterone, and progesterone, contribute to the sexually dimorphic characteristics and prevalence of migraine in men and women. Recent neuroimaging studies have indicated that migraine may have a greater impact and cause greater dysfunction in the organization of resting-state functional networks in women. Accumulating evidence suggests that topiramate, Onabotulinumtoxin A and calcitonin gene-related peptide (CGRP) monoclonal antibodies are effective as the preventative treatments for CM. Recent evidence highlights a divergence in the characteristics of CM between male and female populations. The data comparing the treatment response for CM regarding sex are lacking.
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Affiliation(s)
- Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chia-Lin Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Guan-Yu Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
| | - Shuu-Jiun Wang
- Neurological Institute, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou 112, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Abstract
Migraine is considered mostly a woman’s complaint, even if it affects also men. Epidemiological data show a higher incidence of the disease in women, starting from puberty throughout life. The sex-related differences of migraine hold clinical relevance too. The frequency, duration, and disability of attacks tend to be higher in women. Because of this, probably, they also consult specialists more frequently and take more prescription drugs than men. Different mechanisms have been evaluated to explain these differences. Hormonal milieu and its modulation of neuronal and vascular reactivity is probably one of the most important aspects. Estrogens and progesterone regulate a host of biological functions through two mechanisms: nongenomic and genomic. They influence several neuromediators and neurotransmitters, and they may cause functional and structural differences in several brain regions, involved in migraine pathogenesis. In addition to their central action, sex hormones exert rapid modulation of vascular tone. The resulting specific sex phenotype should be considered during clinical management and experimental studies.
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Huang X, Zhang D, Wang P, Mao C, Miao Z, Liu C, Xu C, Yin X, Wu X. Altered amygdala effective connectivity in migraine without aura: evidence from resting-state fMRI with Granger causality analysis. J Headache Pain 2021; 22:25. [PMID: 33858323 PMCID: PMC8048057 DOI: 10.1186/s10194-021-01240-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/05/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Granger causality analysis (GCA) has been used to investigate the pathophysiology of migraine. Amygdala plays a key role in pain modulation of migraine attack. However, the detailed neuromechanism remained to be elucidated. We applied GCA to explore the amygdala-based directional effective connectivity in migraine without aura (MwoA) and to determine the relation with clinical characteristics. METHODS Forty-five MwoA patients and forty age-, sex-, and years of education-matched healthy controls(HCs) underwent resting-state functional magnetic resonance imaging (fMRI). Bilateral amygdala were used as seed regions in GCA to investigate directional effective connectivity and relation with migraine duration or attack frequency. RESULTS MwoA patients showed significantly decreased effective connectivity from right amygdala to right superior temporal gyrus, left superior temporal gyrus and right precentral gyrus compared with HCs. Furthermore, MwoA patients demonstrated significantly decreased effective connectivity from the left amygdala to the ipsilateral superior temporal gyrus. Also, MwoA patients showed enhanced effective connectivity from left inferior frontal gyrus to left amygdala. Effective connectivity outflow from right amygdala to right precentral gyrus was negatively correlated to disease duration. CONCLUSIONS Altered directional effective connectivity of amygdala demonstrated that neurolimbic pain networks contribute to multisensory integration abnormalities and deficits in pain modulation of MwoA patients.
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Affiliation(s)
- Xiaobin Huang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Di Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Cunnan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Zhengfei Miao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Chunmei Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, Jiangsu Province, China
| | - Chenjie Xu
- Department of Pain Treatment, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, Jiangsu Province, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Xinying Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China.
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Al-Hassany L, Haas J, Piccininni M, Kurth T, Maassen Van Den Brink A, Rohmann JL. Giving Researchers a Headache - Sex and Gender Differences in Migraine. Front Neurol 2020; 11:549038. [PMID: 33192977 PMCID: PMC7642465 DOI: 10.3389/fneur.2020.549038] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/10/2020] [Indexed: 12/26/2022] Open
Abstract
Migraine is a common neurovascular disorder affecting ~15% of the general population. Ranking second in the list of years lived with disability (YLD), people living with migraine are greatly impacted by this especially burdensome primary headache disorder. In ~30% of individuals with migraine, transient neurological symptoms occur (migraine aura) that further increase migraine burden. However, migraine burden is differential with respect to sex. Though one-year prevalences in childhood are similar, starting with puberty, migraine incidence increases at a much higher rate in females than males. Thus, migraine over the life course occurs in women three to four times more often than in men. Attacks are also more severe in women, leading to greater disability and a longer recovery period. The sex disparity in migraine is believed to be partly mediated through fluctuations in ovarian steroid hormones, especially estrogen and progesterone, although the exact mechanisms are not yet completely understood. The release of the neuropeptide calcitonin gene-related peptide (CGRP), followed by activation of the trigeminovascular system, is thought to play a key role in the migraine pathophysiology. Given the burden of migraine and its disproportionate distribution, the underlying cause(s) for the observed differences between sexes in the incidence, frequency, and intensity of migraine attacks must be better understood. Relevant biological as well as behavioral differences must be taken into account. To evaluate the scope of the existing knowledge on the issue of biological sex as well as gender differences in migraine, we conducted a systematized review of the currently available research. The review seeks to harmonize existing knowledge on the topic across the domains of biological/preclinical, clinical, and population-level research, which are traditionally synthesized and interpreted in isolation. Ultimately, we identify knowledge gaps and set priorities for further interdisciplinary and informed research on sex and gender differences as well as gender-specific therapies in migraine.
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Affiliation(s)
- Linda Al-Hassany
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jennifer Haas
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Piccininni
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antoinette Maassen Van Den Brink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jessica L Rohmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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