While it is known that heightened estrogen levels are linked to an increased prevalence of migraine in women, new research suggests that the hormone plays an equally important role in causing migraine among men.
Previous studies have pointed to increased estrogen levels accounting for the higher migraine prevalence in women. During childbearing years, women (24%) are 3-times more likely than men (8%) to experience migraine; additionally, they may experience a more frequently and severe form of migraine.
Now, new research suggests that the hormone also plays a role in migraine prevalence among men. A study of 39 men found that those affected by migraine had higher levels of estradiol, an estrogen, than those without migraine.
Researchers recruited 17 participants experiencing migraine headaches and 22 controls from a nationwide public announcement, advertising in the press, and the research website. Participants with migraine experienced migraine an average of 3 times per month. Four blood samples were drawn from each participant on a single day, 3 hours apart, to test levels of estradiol and testosterone. For participants with migraine, the first blood samples were collected on a nonmigraine day and, in addition, blood samples were drawn on each day thereafter until they had a migraine.
Participants were surveyed about the presence and characteristics of migraine and premonitory symptoms, including changes in appetite, difficulty concentrating, mood changes, and fatigue. They also answered 2 questionnaires revolving around symptoms related to deficiency in testosterone, such as mood and sexual disorders.
Compared to controls, men with migraine had higher levels of estrogen between migraine attacks (69 picomoles per liter vs 97 picomoles per liter). Testosterone levels were similar among both groups, which resulted in a lower ratio of testosterone to estrogen inbetween migraines for the test subjects. Notably, testosterone levels did increase 24 hours before a migraine attack in men who indicated pre-migraine symptoms such as change in appetite, difficulty concentrating, and fatigue.
A total of 61% of men with migraine reported symptoms associated with testosterone deficiency, compared to 27% of men without migraine. Symptoms were also more severe in men with migraine.
The researchers noted that further studies of larger populations are needed to validate these findings. “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,” they concluded.
Oosterhout W, Shoonman G, van Zwet E, et al. Female sex hormones in men with migraine [published online June 27, 2018]. Neurology. doi: https://doi.org/10.1212/WNL.0000000000005855.