The Complex Relationship between Estrogen and Migraines: A Scoping Review
Background:Migraine headaches are a chronic and complex medical issue for millions of patients worldwide. Despite how common migraines are, there is much to be unveiled regarding their pathogenesis due to the numerous factors implicated in the pathophysiology of migraines. Migraines are significantly more common in women and many female migrainers notice menstrual associations of their headaches. Because of this, migraines have popularly been hypothesized to be largely hormonally mediated.
... ally mediated. Estrogen has been commonly implicated in migraine pathogenesis yet its exact role in the pathophysiology of migraines has yet to be fully understood. Methods: We conducted a scoping review of the literature regarding estrogen's role in migraine pathogenesis and included 11 studies out of an initial 199 in the final review. Results: The estrogen withdrawal hypothesis is the most discussed theory about estrogen's role in migraine physiology and describes the association of migraine onset with natural declines in estrogen levels. Estrogen is also implicated in biochemical pain pathways, and specifically effects pain processing, trigeminal nociception, and neural inflammatory peptides. Human studies have been conducted in female populations such as pregnant women and postmenopausal women, and these studies have supported the estrogen withdrawal hypothesis.Conclusions: Hormone replacement therapy remains to treat migraines is promising, yet still lacks definitive evidence in its efficacy. More primary research into estrogen's mechanisms in migraine pathogenesis is needed, as its specific roles are still unclear. While human-based, clinical trials on the subject are rare, they would provide great insight into migraines and would allow clinicians to better treat patients. Systematic Review registrations: none