The Role of Sex Hormones in Primary Headaches: a Review

Little research has examined the role of sex hormones in primary headaches in the elderly, or in men.

Little research has examined the role of sex hormones in primary headaches in the elderly and men, according to a literature review published in the Journal of Headache and Pain.

PUBMED was systematically searched by 2 independent reviewers, both of whom sought studies with headache-related terms, such as luteinizing hormone (LH), follicular stimulating hormone (FSH), progesterone, estrogen, dehydroepiandrosterone (DHEA), prolactin, testosterone, androgen, headache, migraine, “tension type,” or cluster headache. Original, full-text studies published after January 1, 1997 were the primary source of material for this analysis.

Migraine was found to be 3.25-fold more prevalent in women vs men, and levels of calcitonin gene-related peptide were found to be higher in women of reproductive age compared with men. In women, migraine appeared to follow a temporal pattern associated with estrogen fluctuations during the reproductive cycle, in line with the “estrogen withdrawal hypothesis,” which postulates that drops in estrogen prior to menstruation increase the risk for migraine attacks. 

Women were also found to be at higher risk for migraine with aura compared with men, with a prevalence between 2.6% and 10.8% and 1.2% and 3.7%, respectively. Headache was found to be an adverse effect of hormonal therapies. Data on the role of hormones other than estrogen and testosterone were sparse.

A limitation of this study was the lack of a meta-analysis to pool data and determine levels of significance.

“Reviewing the available literature on this matter, we can conclude that especially the role of estrogen in female [patients with] migraine has been well-studied,” the researchers concluded. “Detailed studies especially in the elderly of both sexes, in [cluster headache], and [tension-type headache] are warranted in order to clearly elucidate the role of sex hormones in not just migraine, but all primary headaches.”

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Delaruelle Z, Ivanova TA, Khan S, et al. Male and female sex hormones in primary headaches. J Headache Pain. 2018;19(1):117.