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Published online before print September 13, 2006, doi:10.1212/01.wnl.0000233888.18228.19)
© 2006 American Academy of Neurology Incidence of migraine relative to menstrual cycle phases of rising and falling estrogenFrom the City of London Migraine Clinic (E.A.M., A.F.), Departments of Gynaecology and Sexual Health (E.A.M.), St Bartholomew's Hospital, and Cancer Research UK and University College London Cancer Trials Centre (A.H.), London, and Unipath Limited (J.E.), Priory Park, Bedford, Unilever Research (L.A.), Colworth House, Sharnbrook, UK. Address correspondence and reprint requests to Dr MacGregor, City of London Migraine Clinic, 22 Charterhouse Square, London, EC1M 6DX, UK; e-mail: anne.macgregor{at}bartsandthelondon.nhs.uk Objective: To investigate the association between urinary hormone levels and migraine, with particular reference to rising and falling levels of estrogen across the menstrual cycle in women with menstrual and menstrually related migraine. Methods: Women with regular menstrual cycles, who were not using hormonal contraception or treatments and who experienced between one and four migraine attacks per month, one of which regularly occurred on or between days 1 ± 2 of menstruation, were studied for three cycles. Women used a fertility monitor to identify ovulation, conducting a test each day as requested by the monitor, using a sample of early morning urine. Urine samples were collected daily for assay of estrone-3-glucuronide, pregnanediol 3-glucuronide, follicle-stimulating hormone, and luteinizing hormone. All women kept a daily migraine diary and continued their usual treatment for migraine. Results: Of 40 women recruited, data from 38 women were available for analysis. Compared with the expected number of attacks, there was a significantly higher number of migraine attacks during the late luteal/early follicular phase of falling estrogen and lower number of attacks during rising phases of estrogen. Conclusion: These findings confirm a relationship between migraine and changing levels of estrogen, supporting the hypothesis of perimenstrual but not postovulatory estrogen "withdrawal" migraine. In addition, rising levels of estrogen appear to offer some protection against migraine.
See also page 2159 This article was previously published in electronic format as an Expedited E-Pub on September 13, 2006, at www.neurology.org Supported by a grant from Unipath Limited. Disclosure: E.A.M. has received consulting fees from Unipath Limited. E.A.M. and A.F. have received funding from Unipath to attend an international meeting. The City of London Migraine Clinic has received research funds from Unipath Limited. Clearblue Easy Fertility Monitors were supplied by Unipath Limited. Received January 13, 2006. Accepted in final form April 27, 2006.
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