Impaired cerebrovascular function may play a role in hormonal migraine


By Natasha Doyle

12 Aug 2021

Abnormal cerebrovascular function may play a role in hormonal migraine development, Australian researchers suggest.

An exploratory study into cerebrovascular function in 50 hormonal migraineurs and 29 non-migraineurs showed hormonal migraineurs had poorer resting mean blood flow velocity and impaired neurovascular coupling in the left middle cerebral artery while migraine- and period-free, compared with controls.

Hormonal migraineurs also had a higher resting heart rate than controls, the authors wrote in Frontiers in Neurology.

Although the study’s cross-sectional nature and single data collection time point prevented the authors establishing a causal relationship between poor cerebrovascular function and hormonal migraine, their observations “implicate abnormal cardiovascular and, in particular, cerebrovascular function in the pathogenesis of hormonal migraine”, they wrote.

Often occurring prior to menstruation or during ovulation, these migraines have previously been linked to sharp drops in oestrogen.

“Oestrogen is vital for the healthy functioning of the vascular endothelium as it reduces inflammation, oxidative stress and cell death and importantly regulates the vasomotor tone of blood vessels,” the authors wrote.

“Hence, it is plausible that hormonal migraineurs may have suboptimal endothelial function and the rapid withdrawal of oestrogen that occurs prior to menstruation or during ovulation may worsen the cerebral endothelial dysfunction and thereby trigger the migraine.”

Additionally, the association between reduced cerebrovascular function and hormonal migraine may partially account for the increased cerebrovascular disease risk in young premenopausal women with migraine, they posited.

However, “longitudinal studies are required to validate our findings”, they wrote. Future studies should also include a non-hormonal migraine control group to determine if and how their cerebrovascular function differs from that of hormonal migraineurs.

Indeed, the researchers recently published a study indicating that non-hormonal migraineurs had higher resting mean blood flow velocity in the anterior and middle cerebral arteries.

Similar to other studies, hormonal migraineurs reported severely impacted quality of life and increased disability, the authors wrote, though limited data meant they couldn’t link these to impaired cerebrovascular function.

Future studies “should investigate whether improvements in cardiovascular function are associated with improvements in migraine-related quality of life, disability, frequency and intensity,” they wrote.

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