A migraine study led by researchers at the UC Medical Center appears as the lead article in the April issue of Headache, the official journal of the American Headache Society. The study, titled "Medical Oophorectomy With and Without Estrogen Add-Back Therapy in the Prevention of Migraine Headache," showed that the use of estrogen patches could prevent migraine headache in women who had undergone a medication-induced menopause.
"We've all heard about the negative effects that estrogen has regarding breast cancer and cardiovascular disease," said Vincent T. Martin, MD, associate professor of clinical medicine at UC and co-director of the Cincinnati Headache Center. "This study demonstrates the positive effects of estrogen on the brain."
Migraine headache afflicts 19-22 million women in the United States and is three times more common in women than men. Sixty percent of women with migraine report that their headaches occur predictably at the time of their menstrual period. Past studies have demonstrated that a "fall in estrogen" that occurs shortly before the menstrual period may provoke these headaches. Changes in estrogen (or other female hormones) at other times of menstrual cycle could also trigger migraine and might explain why migraine is more common in women than men.
The study, conducted at UC, was designed to evaluate whether "leveling out" of hormonal changes in menstruating women could reduce the severity and/or impact of migraine headache. Twenty-one menstruating women (average age 39) with migraine had their ovaries temporarily turned off with a drug called goserelin to eliminate changing hormone levels in their blood stream. One-half of the women then received a 100 microgram estrogen patch while the other half received a placebo patch (no hormone given). Both the estrogen and placebo patches maintained non-changing estrogen levels in the bloodstream, but only the estrogen patch prevented migraine headache. This indicates that minimization of estrogen fluctuations alone is insufficient to prevent headache, but that some estrogen must be present in the bloodstream to reduce the severity and disability of migraine headache.
These and other results would suggest that estrogen can both "provoke" and "prevent" migraine headache. Migraine may be provoked when estrogen levels decline (as encountered at the time of the menstrual period), but migraine may be prevented when constant, non-fluctuating levels of estrogen are maintained with an estrogen patch. This represents one of the first studies to document a clear preventative benefit of daily administration of the estrogen patch in the prevention of migraine headache, and could have important implications to the vast number of women with migraine receiving hormone replacement therapy.
Researchers affiliated with this study include: Dr. Martin, principal investigator; Suzanne Wernke MD, PhD, assistant professor, UC; Karen Mandell, PharmD, UC; Willie Zoma, MD, Baystate Medical Center; James Liu, MD, University Hospitals of Cleveland and Case Western University; Judy Bean, PhD, Children's Hospital Medical Center, Cincinnati; Nabih Ramadan, MD, Eli Lilly and Company and Indiana School of Medicine; Robert Rebar, MD, American Society of Reproductive Medicine.