Fila Michal, Przyslo Lukasz, Derwich Marcin, Pawlowska Elzbieta, Blasiak Janusz
Department of Developmental Neurology and Epileptology, Polish Mother's Memorial Hospital Research Institute, 93-338, Lodz, Poland.
Department of Developmental Dentistry, Medical University of Lodz, 90-647, Lodz, Poland.
Curr Pain Headache Rep. 2025 Jan 6;29(1):11. doi: 10.1007/s11916-024-01317-4.
Migraine prevalence in females is up to 3 times higher than in males and females show higher frequency, longer duration, and increased severity of headache attacks, but the reason for that difference is not known. This narrative review presents the main aspects of sex dimorphism in migraine prevalence and discusses the role of sex-related differences in mitochondrial homeostasis in that dimorphism. The gender dimension is also shortly addressed.
The imbalance between energy production and demand in the brain susceptible to migraine is an important element of migraine pathogenesis. Mitochondria are the main energy source in the brain and mitochondrial impairment is reported in both migraine patients and animal models of human migraine. However, it is not known whether the observed changes are consequences of primary disturbance of mitochondrial homeostasis or are secondary to the migraine-affected hyperexcitable brain. Sex hormones regulate mitochondrial homeostasis, and several reports suggest that the female hormones may act protectively against mitochondrial impairment, contributing to more effective energy production in females, which may be utilized in the mechanisms responsible for migraine progression. Migraine is characterized by several comorbidities that are characterized by sex dimorphism in their prevalence and impairments in mitochondrial functions. Mitochondria may play a major role in sexual dimorphism in migraine through the involvement in energy production, the dependence on sex hormones, and the involvement in sex-dependent comorbidities. Studies on the role of mitochondria in sex dimorphism in migraine may contribute to precise personal therapeutic strategies.
偏头痛在女性中的患病率比男性高至多3倍，且女性偏头痛发作的频率更高、持续时间更长、严重程度更高，但造成这种差异的原因尚不清楚。本叙述性综述介绍了偏头痛患病率性别差异的主要方面，并讨论了线粒体稳态中性别相关差异在这种差异中的作用。同时也简要探讨了性别维度。
易患偏头痛的大脑中能量产生与需求之间的失衡是偏头痛发病机制的一个重要因素。线粒体是大脑的主要能量来源，偏头痛患者和人类偏头痛动物模型中均有线粒体损伤的报道。然而，尚不清楚所观察到的变化是线粒体稳态原发性紊乱的结果，还是继发于受偏头痛影响的过度兴奋的大脑。性激素调节线粒体稳态，一些报告表明，女性激素可能对线粒体损伤起到保护作用，有助于女性更有效地产生能量，这可能参与了偏头痛进展的机制。偏头痛的特征是伴有几种合并症，这些合并症在患病率和线粒体功能损伤方面存在性别差异。线粒体可能通过参与能量产生、对性激素的依赖性以及参与性别相关的合并症，在偏头痛的性别差异中发挥主要作用。关于线粒体在偏头痛性别差异中的作用的研究可能有助于制定精确的个性化治疗策略。
