Background: Migraine is a genetically influenced complex disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and increased sensitivity to light and sound. It is a common cause of disability and loss of work. The most common type of migraine is without aura (75% of cases). Migraine is more prevalent in women as compared with men, specifically during reproductive years. Recent studies have found differences in headache characteristics, central nervous system anatomy, as well as functional activation by fMRI between the sexes in migraine patients. Although the cause underlying these differences is likely multifactorial, considerable evidence supports an important role for sex hormones. Estrogen and testosterone regulate a host of biological functions through two mechanisms: nongenomic and genomic. Owing to their lipophilic nature and low molecular weight, sex hormones can cross the blood-brain barrier, resulting in similar concentrations in systemic and cerebral circulation. Female sex hormones modulate the action of many other hormones and vasoactive neuro-mediators implicated in the onset of migraine. Aim of study: To asses interictal, and ictal levels of 17β-estradiol, free testosterone (Tf) and the Tf to 17β-estradiol ratio in men with migraine. Methods : We measured 17β-estradiol (E2) and calculated free testosterone (Tf) in serum of 25 medication-free men with migraine and 25 men without migraine group-matched for age. Blood was sampled for migraineurs interictal, day at 9 AM and measured again when an attack occurred. Clinical androgen deficiency was assessed with the Androgen Deficiency of Ageing Men questionnaire. We analyzed interictal data (mean ± standard error) with analysis of covariance and longitudinal data by generalized estimated equations models. Results: Compared to controls, men with migraine had a lower interictal Tf/E2 ratio (3.5 ± 0.8 vs 4.2 ± 1.1, p = 0.007) due to higher E2 (31.6 ± 7.0 vs 24.3 ± 7.8 pmol/L, p = 0.001) and similar Tf (105.6 ± 19.0 vs 109.3 ± 32.9 pmol/L, p=0.625) levels. Interictal Tf levels were increased in men with migraine reporting premonitory symptoms (p=0.013). Men with migraine more frequently reported symptoms of androgen deficiency (13 of 25 [52%] vs 6 of 25 [24%], p = 0.041). Conclusions: In this study, men with migraine exhibited increased levels of the sex hormone estradiol and showed clinical evidence of relative androgen deficiency. The role of estradiol in modulating migraine susceptibility and activity in men deserves further investigations. |
