A new study has found that estrogen levels fluctuate in women with migraine because the level of the protein calcitonin gene-related peptide (CGRP), which plays a key role in initiating the migraine process, fluctuates. The study is published in the online edition of Neurology, the medical journal of the American Academy of Neurology.
“This increased level of CGRP after hormonal fluctuations could help explain why migraine attacks are more likely during menstruation and why migraine attacks gradually subside after menopause,” said study author Bianca Raffaelli, MD, of Charite – Universitatsmedizin Berlin in Germany. “These results need to be confirmed in larger studies, but we hope they will help us better understand the migraine process.”
Three groups of participants with episodic migraine were involved in the study. All had at least three migraine days in the month before the study. The groups were those with regular menstrual cycles, those using oral contraceptives, and those who had gone through menopause. Each group was compared to a group of age-matched participants who did not have migraines. Each group had 30 people, 180 in total.
The researchers took blood and tear fluid to determine CGRP levels. For patients with regular menstrual cycles, samples were taken during menstruation, when estrogen levels are low, and around the time of ovulation, when levels are highest. For those using oral contraceptives, samples were collected while off hormones and while on hormones. Samples were collected once from postmenopausal participants at a random time.
The study found that participants with migraines and regular menstrual cycles had higher CGRP concentrations during menstruation than women without migraines. Migraine patients had blood levels of 5.95 picograms per milliliter (pg/ml), compared with 4.61 pg/ml in people without migraine. In tear fluid, migraine patients had 1.20 nanograms per milliliter (ng/ml), compared with 0.4 ng/ml in non-migraine patients.
In contrast, oral contraceptive and postmenopausal women had similar CGRP levels in the migraine and non-migraine groups.
“The study also suggests that measuring CGRP levels through tear fluid is feasible and warrants further investigation, as accurate measurement in blood is challenging due to its very short half-life,” Raffaelli said. “This method is still exploratory, but it is non-invasive.
Raffaelli noted that while hormone levels were measured around the time of ovulation, they may not have been taken on the exact day of ovulation, so fluctuations in estrogen levels may not be fully reflected.
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