From the Departments of Neurology (W.P.J.v.O., G.G.S., G.M.T, M.D.F.), Medical Statistics (E.W.v.Z.), and Endocrinology (O.M.D.), Leiden University Medical Center, Rotterdam; Department of Neurology (W.P.J.v.O.), OLVG Hospital, Amsterdam; Department of Neurology (G.G.S.), Elisabeth Tweesteden Hospital, Tilburg; and Department of Internal Medicine (A.M.), Division of Vascular Medicine and Pharmacology, Erasmus Medical Centre, Rotterdam, the Netherlands.
Neurology. 2018 Jul 24;91(4):e374-e381. doi: 10.1212/WNL.0000000000005855. Epub 2018 Jun 27.
To assess the role of estradiol and testosterone in men with migraine.
We measured 17β-estradiol (E2) and calculated free testosterone (T) in serum of 17 medication-free men with migraine and 22 men without migraine group-matched for age and body mass index (BMI), targeted at 20 to 28 kg/m. Blood was sampled on a single, for migraineurs interictal, day at 9 am, 12 pm, 3 pm, and 6 pm. Migraineurs were subsequently measured 3 to 4 times daily until an attack occurred. Clinical androgen deficiency was assessed with the Androgen Deficiency of Ageing Men questionnaire and the Aging Males' Symptoms (AMS) scale. We analyzed interictal data (mean ± standard error) with repeated-measures analysis of covariance and longitudinal data by generalized estimated equations models.
Compared to controls, men with migraine had a lower interictal T/E2 ratio (3.9 ± 0.4 vs 5.0 ± 0.3, = 0.03) due to higher E2 (96.8 ± 6.1 vs 69.1 ± 5.6 pmol/L, = 0.001) and similar T (357.5 ± 21.4 vs 332.6 ± 18.7 pmol/L, = 0.35) levels. Preictal T levels were increased in men with migraine reporting premonitory symptoms ( = 0.03). Men with migraine more frequently reported symptoms of androgen deficiency (11 of 18 [61.1%] vs 6 of 22 [27.3%], = 0.031), which were also more frequently severe ( = 0.006); their age- and BMI-adjusted AMS scores were higher (27.0 ± 1.2 vs 21.0 ± 1.0, = 0.002).
In this study, nonobese men with migraine exhibited increased levels of the sex hormone estradiol and showed clinical evidence of relative androgen deficiency. The role of estradiol in modulating migraine susceptibility and activity in men deserves further investigations.
评估雌二醇和睾酮在偏头痛男性中的作用。
我们测量了 17 名无药物治疗的偏头痛男性和 22 名年龄和体重指数（BMI）相匹配的无偏头痛男性的血清 17β-雌二醇（E2）并计算了游离睾酮（T），目标值为 20 至 28 kg/m。偏头痛患者在一天中的上午 9 点、中午 12 点、下午 3 点和下午 6 点进行单次采血，随后直至发作时每天测量 3 至 4 次。通过雄激素缺乏老年男性问卷和男性衰老症状（AMS）量表评估临床雄激素缺乏。我们使用重复测量方差分析和广义估计方程模型对间歇期数据（平均值±标准误差）和纵向数据进行分析。
与对照组相比，偏头痛男性的间歇期 T/E2 比值较低（3.9±0.4 对 5.0±0.3， = 0.03），原因是 E2 水平较高（96.8±6.1 对 69.1±5.6 pmol/L， = 0.001），而 T 水平相似（357.5±21.4 对 332.6±18.7 pmol/L， = 0.35）。有先兆症状的偏头痛男性的预发性 T 水平升高（ = 0.03）。偏头痛男性更频繁地报告雄激素缺乏症状（18 名中的 11 名[61.1%]对 22 名中的 6 名[27.3%]， = 0.031），这些症状也更严重（ = 0.006）；他们的年龄和 BMI 调整后的 AMS 评分较高（27.0±1.2 对 21.0±1.0， = 0.002）。
在这项研究中，非肥胖的偏头痛男性表现出较高水平的性激素雌二醇，并表现出相对雄激素缺乏的临床证据。雌二醇在调节男性偏头痛易感性和活动中的作用值得进一步研究。
