Men with migraines were found to have increased levels of estradiol and to be more likely to have relative androgen deficiency compared with men without migraines, according to a study published in Neurology.
The study included men with migraine who were medication free (n=17) and age- and body mass index (BMI)-matched with control participants without migraine (n=22). For each participant, serum levels of 17β-estradiol (E2) and serum-free testosterone (Tf) were measured. Blood samples were drawn on a single day at 9 am, 12 pm, 3 pm, and 6 pm. For participants with migraine, the blood was drawn on an interictal day and again 3 to 4 times daily thereafter until an attack occurred. Clinical androgen deficiency was assessed using the Androgen Deficiency of Ageing Men questionnaire and the Aging Males’ Symptoms scale.
Participants with migraine had a lower interictal Tf/E2 ratio compared with controls (3.9±0.4 vs 5.0±0.3, respectively; P =.03), Tf serum levels similar to those of control participants (357.5±21.4 pmol/L vs 332.6±18.7 pmol/L, respectively; P =.35), and higher E2 levels (96.8±6.1 pmol/L vs 69.1±5.6 pmol/L, respectively; P =.001). In participants with migraine who reported premonitory symptoms, preictal Tf levels were increased (P =.03). Study participants with migraine reported symptoms of androgen deficiency more frequently compared with controls (61.1% vs 27.3%, respectively; P =.031). These symptoms were more frequently severe in men with vs without migraine (P =.006), with age- and BMI-adjusted Aging Males’ Symptoms scale scores of 27.0±1.2 for participants with migraine compared with 21.0±1.0 for controls (P =.002).
These results indicate the need to investigate what role estradiol plays in modulating migraine susceptibility and activity in men.
“What exactly the role of estradiol is in men with migraine and whether fluctuations in estradiol levels, as in women, might be associated with changes in migraine activity deserve further intraindividual follow-up studies over multiple attack cycles,” the researchers wrote.
van Oosterhout WPJ, Schoonman GG, van Zwet EW, et al. Female sex hormones in men with migraine [published online June 27, 2018]. Neurology. doi: 10.1212/WNL.0000000000005855