Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Migraines may occur at any time during the menstrual cycle but are commonly associated with the menses. Migraine-specific medications, such as the triptans, may be effective for acute management of menstrual migraine. However, it is important to recognize the relationship between migraines and the menstrual cycle because these headaches may not respond to the usual antimigraine medications. In that case, management may involve perimenstrual migraine prophylaxis, with migraine-specific medications used in addition for severe breakthrough migraines. Prostaglandin inhibitors started just before the time of headache vulnerability may prevent menstrual migraine attacks or reduce the severity of the headaches. Estrogen withdrawal has been shown to precipitate migraine headaches, and a sustained elevated level of estrogen will postpone the migraine. Transdermal estrogen started just before menstruation can provide a sustained low level of estrogen, decreasing the degree of estrogen decline, and thus may prevent induction of migraines. Ergotamine tartrate is usually taken only for acute migraine, but may also be effective for prevention of menstrual migraine when used regularly once or twice per day during the time of risk. By understanding the underlying pathophysiology of the relationship between migraines and the menstrual cycle, the physician can successfully treat migraines associated with menses.
 ...
PMID:Management of menstrual migraine. 1048 8

Migraine in women is influenced by hormonal changes throughout the life cycle: menarche, menstruation, oral contraceptive use, pregnancy, menopause, and hormonal replacement therapy (HRT). Based on clinical experience, the frequency of menstrual migraine has been reported to be as high as 60%-70%. Most women have increased headache and migraine attacks (usually without aura) at the time of menses. Attacks occurring only with menstruation, even if infrequent, are called true menstrual migraine. Attacks occurring both at menstruation and at other times of the month could be called "menstrually triggered migraine." Menstrual migraine occurs at the time of the greatest fluctuation in estrogen levels. Estrogen withdrawal is probably the trigger for migraine attacks in susceptible women. Drugs that are proven effective or commonly used for the acute treatment of menstrual migraine include nonsteroidal anti-inflammatory drugs (NSAIDs), dihydroergotamine, the triptans, and the combination of aspirin, acetaminophen, and caffeine. The goal of standard continuous preventive therapy is to reduce the frequency, duration, and intensity of attacks. Preventive therapy may eliminate all headaches except those associated with menses. Women already using prophylactic medication who continue to have menstrual migraine can increase the dose of their medication prior to their menses. Women who do not use preventive medicine or have migraine exclusively with their menses can be treated perimenstrually with short-term prophylaxis. If severe menstrual migraine cannot be controlled by acute and preventive treatment, hormonal therapy may be indicated.
 ...
PMID:Menstrual migraine. 1053 94

The normal female life cycle is associated with a number of hormonal milestones: menarche, pregnancy, contraceptive use, menopause, and the use of replacement sex hormones. Menarche marks the onset of menses and cyclic changes in hormone levels. Pregnancy is associated with rising noncyclic levels of sex hormones, and menopause with declining noncyclic levels. Hormonal contraceptive use during the reproductive years and hormone replacement in menopause are therapeutic hormonal interventions that alter the levels and cycling of sex hormones. These events and interventions may cause a change in the prevalence or intensity of headache. The menstrual cycle is the result of a carefully orchestrated sequence of interactions between the hypothalamus, pituitary, ovary, and endometrium, with the sex hormones acting as modulators and effectors at each level. Estrogen and progestins have potent effects on central serotonergic and opioid neurons, modulating both neuronal activity and receptor density. The primary trigger of Menstrually-related migraine (MM) appears to be the withdrawal of estrogen rather than the maintenance of sustained high or low estrogen levels. However, changes in the sustained estrogen levels with pregnancy (increased) and menopause (decreased) appear to affect headaches. Headaches associated with OC use or menopausal hormonal replacement therapy may be related, in part, to periodic discontinuation of oral sex hormone preparations. The treatment of migraine associated with changes in sex hormone levels is frequently difficult and the patients are often refractory to therapy. Based on what is known of the pathophysiology of migraine, we have attempted to provide a logical approach to the treatment of headaches that are associated with menses, menopause, and OCs using abortive and preventive medications and hormonal manipulations. Considerable evidence suggests a link between estrogen and progesterone, the female sex hormones, and migraine. (Silberstein and Merriam, 1997; Lipton and Stewart, 1993; Epstein et al., 1975; Goldstein and Chen, 1982; Selby and Lance, 1960) Although no gender difference is apparent in prepubertal children, with migraine occurring equally in 4p. 100 of boys and girls, (Goldstein and Chen, 1982, Waters and O'Connor, 1971) migraine occurs more frequently in adult women (18p. 100) than in men (6p. 100). (Lipton and Stewart, 1993) Migraine develops most frequently in the second decade, with the peak incidence occurring with adolescence. (Selby and Lance, 1960; Epstein et al., 1975) Menstrually-related migraine (MM) begins at menarche in 33p. 100 of affected women (Epstein et al. , 1975). MM occurs mainly at the time of menses in many migrainous women, and exclusively with menses (true menstrual migraine [TMM]) in some (Epstein et al., 1975). Menstrual migraine can be associated with other somatic complaints arising before and often persisting into menses, such as nausea, backache, breast tenderness, and cramps and like them appears to be the result of falling sex hormone levels (Silberstein and Merriam, 1997; American Psychiatric Association, 1994). In addition, premenstrual migraine can be associated with premenstrual dysphoric disorder (PDD), also called "premenstrual syndrome" (PMS), which is distinct from the physical symptoms of the perimenstrual period and is probably not directly driven by declining progesterone levels (Mortola, 1998). Migraine occurring during (rather than prior to) menstruation is usually not associated with PMS (Silberstein and Merriam, 1997). Migraine may worsen during the first trimester of pregnancy and, although many women become headache-free during the last two trimesters, 25p. 100 have no change in their migraine (Silberstein, 1997). MM typically improves with pregnancy, perhaps due to sustained high estrogen levels (Silberstein, 1997). Hormonal replacement with estrogens can exacerbate migraine and oral contraceptives (OCs) can change its character and frequency
 ...
PMID:Sex hormones and headache. 1113 45

Of the nearly 20 million American women suffering with migraine, approximately 12 million experience a worsening of their migraines in association with their menstrual cycle. Prior to puberty the prevalence of migraine is slightly higher in boys; however, after puberty there is an emerging female predominance. Estrogen likely plays an important role in explaining this gender difference; however, hormones unlikely explain the entire epidemiologic variation. This article reviews the diagnosis and treatment options for menstrually associated migraine.
Curr Pain Headache Rep 2001 Apr
PMID:Menstrual migraine: diagnosis and treatment. 1125 55

The vast majority of people experience tension-type headache during their lifetimes. Boys experience tension-type headache slightly more than girls during preadolescent years. During adolescence and adult years, tension-type headache occurs more commonly in females. Tension-type headache changes in women occur in relation to gynecologic changes, including menses, pregnancy, and menopause. These changes are related to estrogen fluctuations. Estrogen fluctuations cause changes in neurochemicals important for pain signal transmission, including serotonin, gamma-aminobutyric acid, and enkephalins.
Curr Pain Headache Rep 2001 Oct
PMID:Estrogen and tension-type headache. 1156 Aug 10

All medications have side effects in certain patients; none is 100% "safe" and the physicain must determine the benefit-to-risk ratio of each contraceptive method for a particular patient. 81% of white, nonCatholic women aged 20-24 who are college graduates use oral contraceptives, an extraordinary acceptance level for a method not even available in 1960. The various preparations available in the U.S, amount of estrogen and progestogen in each, and side effects are then surveyed. Estrogen irritates the gastric mucosa and diminishes rate of sodium excretion by the kidneys; this causes the nausea, edema, general bloating, tension, and headaches which most commonly cause women to discontinue the medication. The patient with full breasts who menstruates normally should not be overloaded with estrogen while a high-estrogen compound might benefit the woman with small breasts and scanty menses. Estrogens are known stimulants for the growth of uterine leiomyomas; if such lesions are present an antiestrogenic progestogen is indicated. High estrogen pills are more likely to stimulate breast growth and increase discomfort from fibrocyctic disease while a progestin-dominant combination will reduce this discomfort. The "19-nor" progestins are essentailly variants of testosterone and may produce hirsutism, alopecia, acne, hypomenorrhea, or even amenorrhea. T hey also may increase appetite and cause excessive weight gain. The total effect is complicated by such factors as the particular progestin used. The 19-norsteroid compounds are partly metabolized to estrogen and increase the estrogenic effect while norgestrel produces antiestrogenic activity. Newer marketing methods have tried to simplify administration by inserting 7 iron tablets or 7 placebos so the user takes a pill every day for 28 days. For patients who have noted side effects during the 7-day interval they are not taking the pill (undoubtedly related to temporary estrogen insufficiency) .02 mg ethinyl estradiol may be used. The sequential method more closely simulates the normal menstrual cycle and can be used to advantage in women who suffer prolonged anovulation after cessaton of combination therapy and in women past 35 in whom the increased risk of pregnancy is offset by declining fertility potential. Both serious and minor adverse reactions to various forms of therapy are detailed. These include cutaneous, nervous system, metabloic, and endocrine system changes.
 ...
PMID:Present status of oral contraceptives: 1. effectiveness; basis for selection; side effects; metabolic changes. 1230 85

There are hormones from 2 sources which determine the menstrual cycle. The pituitary produces luteinizing hormone and follicle stimulating hormone and the ovaries secrete estrogen and progesterone. For clinical use, a cheap source of progesterone has been found in the Mexican yam. Since the 1st oral contraceptives were tested in Puerto Rico in the late 1950s, there has been a trend toward reducing the dosage. Estrogen prevents ovulation in 95-98% of patients. Other factors are also involved. Although it is estimated that 80-100 million women in the world today use oral contraceptives, this method is not always followed for long periods. From 25 to 60% discontinue the use within the 1st year. Increased risk of unfavorable side effects occurs in those with high blood pressure, migraine headaches, diabetes, epilepsy, undiagnosed genital bleeding, or gallbladder disease. Women over age 40 run a greater risk of heart attacks. Intravenous blood clots are the major risk. Severe abdominal, chest, or leg pains, severe headaches, and eye problems may be symptoms of blood clots. With the 21-day package the user takes a pill a day for 3 weeks and then none during menstruation. The sequential type of medication is no longer used. Minipills are taken every day. Missing taking pills is the most common cause of failure of the method. Estrogen replacement therapy for menopausal women is a temporary treatment to relieve physical distress. Depo-Provera, containing a long-acting progesterone agent, may be injected every 3 months instead of daily oral contraceptives. When progesterone is used with an IUD it acts locally. Hormones to maintain pregnancy are no longer used. Use of hormones as a test for pregnancy has been discontinued. Estrogen-progesterone injections given to inhibit milk production may cause serious side effects.
 ...
PMID:The pills: oral contraceptives and other hormones. 1230 26

Estrogen exerts a strong influence on episodic headaches, such as migraine and tension-type headache. A relationship between sex hormones and chronic daily headache (CDH) is less well established. However, similarities between episodic and CDH suggest that estrogen also may significantly influence CDH. Pathophysiologic studies of CDH identify neurochemical abnormalities similar to those influenced by estrogen in episodic headache, such as aberrant 5-hydroxytryptamine activity. In addition, gender differences in CDH prevalence in pediatric and adult populations support a hormonal influence. Few studies have evaluated the ability of gynecologic events, such as menses, to influence CDH.
Curr Pain Headache Rep 2004 Feb
PMID:Estrogen and chronic daily headache. 1473 85

Migraine headache is strongly influenced by reproductive events that occur throughout the lifespan of women. Each of these reproductive events has a different "hormonal milieu," which might modulate the clinical course of migraine headache. Estrogen and progesterone can be preventative or provocative for migraine headache under different circumstances depending on their absolute serum levels, constancy of exposure, and types of estrogen/progesterone derivatives. Attacks of migraine with and without aura respond differently to changes in ovarian hormones. Clearly a greater knowledge of ovarian hormones and their effect on migraine is essential to a greater understanding of the mechanisms and pathogenesis of migraine headache.
Headache 2006 Mar
PMID:Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis--part 2. 1661 54

More than 20 million US women suffer with migraine, two thirds of whom experience menstrually related migraine. Estrogen plays an important role in triggering migraine, and given the numerous hormonal fluctuations throughout a woman's lifetime, there are many opportunities for a hormonal impact. Accurate diagnosis is key to initiating effective treatment, and when acute therapy fails, the unique predictability of menstrual migraine lends itself to preventative treatment.
Curr Pain Headache Rep 2007 Jun
PMID:Preventative treatment of menstrual migraine. 1750 50


<< Previous 1 2 3 4 Next >>