Summary: A small study finds that men who suffer migraines have higher blood levels of estrogen than men who do not experience these disabling headaches.
Source: AAN
Estrogen, a hormone long associated with migraine in women, may also be linked to migraine in men, according to a small study published in the June 27, 2018, online issue of Neurology.
Migraine is a disabling neurological disorder characterized by recurring attacks of intense headache often accompanied by other symptoms. During the years when women can bear children, migraine affects women about three times more often than men, and previous work has shown that fluctuations in female sex hormones can influence migraine timing and severity in women.
“Previous research has found that levels of estrogen can influence when women have migraines and how severe they are, but little is known about whether sex hormones also affect migraine in men,” said study author W.P.J. van Oosterhout, MD, of Leiden University Medical Centre in the Netherlands. “Our research found increased levels of estrogen in men with migraine, as well as symptoms consistent with relatively lower testosterone.”
The study compared 17 men with migraine—average age 47, experiencing roughly three attacks per month—and 22 men without migraine. Participants were medication-free regarding drugs known to influence hormone levels and were matched for age, body mass index, and healthy weight.
Investigators measured 17β-estradiol (a primary form of estrogen) and calculated free testosterone in blood samples taken four times across a single day at three-hour intervals (9 AM, 12 PM, 3 PM and 6 PM). For the men with migraine, sampling began on a day without an attack and continued daily until a migraine occurred, allowing comparison of interictal (between-attacks) and preictal (just before an attack) hormone levels.
Key findings showed that men with migraine had higher interictal estradiol levels (about 97 picomoles per liter) compared with men without migraine (about 69 pmol/L). Testosterone concentrations were similar between groups, which produced a lower testosterone-to-estradiol ratio in men with migraine (approximately 3.9 versus 5.0 in controls). In men who reported premonitory symptoms—such as fatigue, muscle stiffness, or food cravings—testosterone rose about 24 hours before the migraine.
The researchers also assessed symptoms commonly associated with androgen (testosterone) deficiency—covering mood, energy and sexual function—using validated questionnaires. Men with migraine more often reported such symptoms and rated them as more severe: 61 percent of men with migraine reported symptoms consistent with relative androgen deficiency, compared with 27 percent of men without migraine.
Study author Van Oosterhout emphasized the need for larger studies to confirm these results and to better understand how estradiol and testosterone may influence migraine susceptibility and attack dynamics in men. “The exact role of estrogen in men with migraine, and whether fluctuations in estrogen may be associated with migraine activity, like they are in women, needs to be fully investigated,” he said.
The authors noted limitations. Enrollment relied in part on questionnaire responses, which raises the possibility that men with more severe migraine were more likely to participate; this could limit how widely the findings apply to all men with migraine.
Funding: The research was funded by the Netherlands Organization for Scientific Research, the Spinoza Premium, and the European Commission.
Source and Publisher: AAN; organized and reported by NeuroscienceNews.com.
Original Research: The study is reported in the article titled “Female sex hormones in men with migraine” by Willebrordus P.J. van Oosterhout and colleagues, published in Neurology on June 27, 2018.
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Chicago: AAN. “Men with Migraine May Have Higher Estrogen Levels.” NeuroscienceNews, June 27, 2018.
Abstract (Revised summary)
Female sex hormones in men with migraine
Objective: To investigate the roles of estradiol and testosterone in men who experience migraine.
Methods: The study measured serum 17β-estradiol and calculated free testosterone in 17 medication-free men with migraine and 22 matched control men without migraine. Blood sampling occurred four times during a single interictal day; migraineurs were then sampled multiple times daily until an attack occurred. Clinical signs of androgen deficiency were assessed with standard questionnaires, and data were analyzed using appropriate repeated-measures and longitudinal statistical models.
Results: Men with migraine exhibited higher interictal estradiol levels and a lower testosterone-to-estradiol ratio compared with controls, while free testosterone did not differ significantly between groups. Testosterone increased preictally in migraineurs who experienced prodromal symptoms. Men with migraine also more frequently reported symptoms consistent with relative androgen deficiency and scored higher on symptom scales adjusted for age and BMI.
Conclusions: In this non-obese, medication-free sample, men with migraine showed increased estradiol and clinical evidence suggesting relative androgen deficiency. These findings warrant further research to determine whether and how estradiol contributes to migraine susceptibility and activity in men.