Two to three times more women suffer from migraine than men. Hormones clearly play a role. But how exactly? Dutch pharmacologist Antoinette Maassen van den Brink of the Erasmus MC Rotterdam did ground-breaking research.
Of all sorts of headache, migraine is the most common: it’s estimated that 1 in 7 people in the UK suffers from it. Dutch researcher and pharmacologist Antoinette Maassen van den Brink of the Erasmus Medical Centre Rotterdam: ‘The World Health Organisation (WHO) considers migraine to be the second most disabling condition in women. If you look at both men and women, it’s listed on the sixth place.’
There are two to three times more women who suffer from migraine than men. And one in ten women suffers from menstrual migraine. ‘It was already clear that there was a link with hormones. Migraine often arises after puberty. But strangely enough, the underlying mechanism of the relation with the menstrual cycle has never been investigated. Often the changing hormone levels in women are considered a disturbance during scientific research and thus left out of the equation. That’s also why most laboratory animals are male.’
Exception to the rule was a small American study in the seventies in which only a few women participated. They were given estrogen, which seemed to possibly postpone migraine attacks. The only problem: once you stop taking it, the migraine will start. Also, estrogen influences and regulates other bodily processes. You can’t just administer it without harmful consequences. In order to develop an effective medicine, you need to understand what’s happening.’
‘Finding 22 women with a regular cycle who didn’t use the contraceptive pill wasn’t easy’
The research by Maassen van den Brink and her team, largely carried out by PhD candidate Khatera Ibrahimi, was a first step into the right direction. ‘We’ve examined about 66 women, partly of reproductive age, partly menopausal and partly a test group. It wasn’t easy to find 22 women with a regular cycle who didn’t use the contraceptive pill; as this is often the first thing recommended against hormonal migraine.’
Also the execution ‘wasn’t easy,’ said the associate professor of the Erasmus MC. ‘It was important for the research that the hormone levels were measured exactly on the first day of the cycle, the day the menstruation starts.’ But it appeared that even the most regular cycle can’t be directed. ‘That first day often coincided with the weekend or a holiday.’
The study mainly focussed on the activity of the fifth cranial nerve, the one responsible for headaches. The researchers discovered that the activity of this nerve changes during the menstrual cycle of healthy women, with a peak measured in the beginning of their cycle. This change didn’t occur in women who suffered from menstrual migraine; their cranial nerve activity stayed the same during the entire cycle.
It was already known that an acute change in hormone levels can evoke a migraine attack. But now the research by the Erasmus MC has showed that the hormone levels from women suffering from menstrual migraines deviate. ‘They appear to have a lower estrogen peak than healthy women and they also seem to react differently to hormonal changes. This study wasn’t set up with the intention of showing different blood levels, so this was a lucky by-catch.’
‘It has been proven that there’s a biological cause. There’s a physical difference. Women aren’t pretending’
So will there finally be an adequate treatment of menstrual migraine in the near future? ‘Unfortunately it isn’t that easy. Because what exactly causes the hormonal difference still isn’t clear. But now it has been proven that there’s a biological cause. There’s a physical difference. Women aren’t pretending.’ And that justifies further research. ‘Important, because migraine is a big, but unfortunately hidden problem. Migraine maybe doesn’t kill you, but it can make your life a hell.’
The next step on the road to a solution has already been taken. End of last year the Migraine Fund was established, which raises funds to finance research into migraine. And within the Erasmus MC, together with the Leiden University Medical Centre (LUMC), the departments of Gynaecology, Neurology and Pharmacology have joined forces for further research. ‘This multidisciplinary approach is very special.’