Menstrual migraine: what it is and does it matter?

Area of Science:

• Neurology
• Neuroscience
• Endocrinology

Background:

• Menstrual migraine (MM) diagnostic criteria are research-based and require validation.
• The precise mechanisms triggering MM attacks during the menstrual cycle remain unclear, leading to undertreatment.
• Existing knowledge focuses on neurobiological processes but lacks comprehensive understanding of MM's onset.

Purpose of the Study:

• To review recent findings on the pathophysiology, epidemiology, disease burden, and treatment of MM.
• To explore the intricate relationship between hormonal factors and MM.
• To identify potential therapeutic targets by understanding neuroendocrine vulnerability in MM.

Main Methods:

• This study is a narrative review of existing literature on menstrual migraine.
• Analysis of research focusing on hormonal influences, neuroinflammation, and the trigeminovascular system.
• Examination of animal model studies investigating gonadal hormone effects on cortical spreading depression.

Main Results:

• Falling estrogen levels are implicated in increased blood vessel susceptibility to prostaglandins, contributing to neurogenic inflammation.
• Fluctuations in ovarian steroid hormones modulate calcitonin gene-related peptide within the trigeminovascular system.
• Gonadal hormones influence cortical spreading depression susceptibility and affect MM attack frequency, severity, and treatment response.

Conclusions:

• Hormonal fluctuations, especially estrogen decline, play a significant role in MM pathophysiology.
• Understanding the neuroendocrine mechanisms underlying MM could lead to disease-specific biomarkers and targeted treatments.
• Further research is essential to improve the management of this debilitating migraine subtype.