The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH, 43212, USA.
Syst Rev. 2021 Mar 10;10(1):72. doi: 10.1186/s13643-021-01618-4.
Migraines are a chronic disease for millions worldwide and have been hypothesized to be hormonally mediated due to their higher prevalence in females and menstrual associations. Estrogen has been commonly implicated in migraine pathogenesis, yet its exact role in the pathophysiology of migraines has yet to be fully understood.
We conducted a scoping review of the literature regarding estrogen's role in migraine pathogenesis and included 19 studies out of an initial 202 in the final review. Two independent reviewers screened and extracted data from included studies based on predetermined inclusions and exclusion criteria.
The estrogen withdrawal hypothesis, discussed by 12 of the reviewed studies, is the most discussed theory about estrogen's role in migraine physiology and describes the association of migraine onset with natural declines in estrogen levels, particularly when estrogen levels fall below 45-50 pg/mL after an extended period of priming. Additional findings suggest that women with a history of migraine have an increased sensitivity to physiologic fluctuations in estradiol levels. Several studies suggest that migraines are associated with menstruation.
It appears that estrogen is very likely to play a key role in migraine pathogenesis, but seems to affect patients in different ways depending on their past medical history, age, and use of hormonal therapy. Further research is warranted to isolate the effects of estrogen in each unique patient population, and we believe that studies comparing menstruating women to postmenopausal women could help shed light in this area.
偏头痛是一种全球性的慢性疾病，由于其在女性中的更高发病率和与月经的关联，人们推测它与激素有关。雌激素通常与偏头痛的发病机制有关，但它在偏头痛病理生理学中的确切作用尚未完全了解。
我们对雌激素在偏头痛发病机制中的作用进行了文献综述，从最初的 202 项研究中纳入了 19 项研究。两名独立的审查员根据预先确定的纳入和排除标准，对纳入研究进行了筛选和提取数据。
12 项综述研究讨论了雌激素撤退假说，这是关于雌激素在偏头痛生理学中作用的最具争议性的理论，描述了偏头痛发作与雌激素水平自然下降的关联，特别是当雌激素水平在延长的前期后降至 45-50 pg/ml 以下时。其他研究结果表明，有偏头痛病史的女性对雌二醇水平的生理波动更加敏感。一些研究表明偏头痛与月经有关。
雌激素很可能在偏头痛的发病机制中发挥关键作用，但似乎根据患者的既往病史、年龄和激素治疗的使用情况，以不同的方式影响患者。需要进一步的研究来分离每个独特的患者群体中雌激素的作用，我们认为比较经期女性和绝经后女性的研究可能有助于阐明这一领域。
