Reduced trigeminovascular cyclicity in patients with menstrually related migraine

Neurology. 2015 Jan 13;84(2):125-31. doi: 10.1212/WNL.0000000000001142. Epub 2014 Dec 10.

Abstract

Objective: A case-control study to investigate the effect of the menstrual cycle on trigeminal nerve-induced vasodilation in healthy women and patients with menstrually related migraine (MRM).

Methods: Using a laser-Doppler imager, we compared the vasodilator effects of capsaicin application and electrical stimulation (ES) on the forehead skin, a trigeminal nerve-innervated dermatome, in premenopausal patients with MRM (n = 22), healthy controls (n = 20), and postmenopausal women without migraine (n = 22). Blood samples were collected for female sex hormone measurements.

Results: Dermal blood flow (DBF) responses to capsaicin were higher in controls during days 1-2 than during days 19-21 of their menstruation cycle (mean Emax ± SEM: 203 ± 28 AU vs 156 ± 27 AU [p = 0.031] for 0.06 mg/mL capsaicin and 497 ± 25 AU vs 456 ± 24 AU [p = 0.009] for 6.0 mg/mL capsaicin). In contrast, patients with MRM demonstrated DBF responses without significant cycle-dependent variability (days 1-2 vs days 19-21: Emax 148 ± 20 AU vs 154 ± 20 AU [p = 0.788] for 0.06 mg/mL capsaicin and 470 ± 17 AU vs 465 ± 20 AU [p = 0.679] for 6.0 mg/mL capsaicin). DBF responses to ES were not different between either patients with MRM or controls, at either occasion. Estradiol levels on days 19-21 of the menstrual cycle were higher in healthy controls (mean ± SEM: 75 ± 8 pg/mL) than in patients with MRM (52 ± 4 pg/mL, p = 0.014). In postmenopausal women, DBF responses to capsaicin and ES, as well as estradiol levels at both visits, were all significantly reduced compared to patients with MRM and controls (in all cases, p < 0.05).

Conclusions: Our study provides evidence for a reduced menstrual cyclicity of both estradiol levels and the trigeminovascular vasodilator system in patients with MRM.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Capsaicin / pharmacology*
  • Case-Control Studies
  • Electric Stimulation*
  • Estrogens / blood
  • Female
  • Forehead
  • Humans
  • Menstruation Disturbances / physiopathology*
  • Middle Aged
  • Migraine Disorders / physiopathology*
  • Periodicity*
  • Progesterone / blood
  • Sensory System Agents / pharmacology*
  • Skin / blood supply*
  • Trigeminal Nerve / drug effects*
  • Vasodilation / drug effects*
  • Young Adult

Substances

  • Estrogens
  • Sensory System Agents
  • Progesterone
  • Capsaicin