Reduction in Estradiol Levels May Aggravate Migraine in Postmenopausal Women

Gianna Melillo

Gianna is an associate editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.

Results of an observational study indicate low estradiol levels could worsen vestibular migraine in postmenopausal women.

Sex hormones are correlated with vestibular migraine (VM) among postmenopausal women, according to observational study results published in the Journal of International Medical Research. The study also found estradiol levels are linked with the duration, frequency, severity of onset, and disease-free survival time of vestibular migraine in this cohort.

Although the relationship between vertigo and headache has been known for many years, the correlation has only been systematically studied within the most recent 2 decades, the researchers explained. The Headache Classification Committee of the International Headache Society defines VM as “recurrent vertigo episodes in patients with a history of migraine or other clinical features of migraine.”

VM can cause intermittent vertigo, nausea, vomiting and motion sensitivity, but its underlying mechanism and its relationship with age, sex, and other demographic features remain unclear.

To better understand the clinical significance of serum sex hormones in postmenopausal women with VM, the researchers conducted a prospective observational study of women over the age of 45 between April 2017 and December 2019. Postmenopausal was defined as the absence of menstruation for more than 1 year.

All participants (n = 242) received their diagnosis of VM based on criteria from the International Classification of Headache Disorders and visited the researchers’ hospital. A control group of 200 healthy postmenopausal women were also included in the study. Blood samples were collected to measure serum sex hormones in addition to patients’ demographic data and clinical characteristics. A visual analogue scale (VAS) was used to determine degree of VM, and all patients were followed-up with for 1 year.

Patients with VM had a mean (SD) age of 54.5 (5.9) years and a mean body mass index of 21 (1.8) kg/m2. Mean age of migraine onset was 51.4 (6) years and for vertigo, 51.5 (6) years.

Analyses revealed:

  • Serum levels of estradiol, progesterone, and testosterone were significantly lower, while serum prolactin levels were significantly higher in postmenopausal patients with VM compared with controls (all P < .05)
  • There was no significant difference in follicle-stimulating hormone or luteinizing hormone levels between patients and controls
  • Estradiol levels were negatively correlated with the duration, frequency, and severity of onset of VM (all P < .001)
  • Patients with low serum estradiol levels showed higher VAS scores, a higher frequency of onset, and longer duration of onset than those with high serum estradiol levels (all P < .05
  • The Kaplan–Meier curve showed that patients with higher serum estradiol levels demonstrated a significantly longer disease-free survival time (P < .001)

“In this study, we found that lower estradiol levels predicted a longer duration, higher frequency, and greater severity of VM, as well as a lower recurrence risk of VM,” the researchers wrote. More research is still required to better identify the features of the condition.

Previous research showed calcitonin gene-related peptide can be regulated by fluctuations in ovarian steroid hormone (mainly estrogen) levels while estrogen can also alleviate neurogenic inflammation via modulation of calcitonin gene-related peptide.

The single-center nature of the study and its limited sample size mark limitations. In addition, the molecular mechanism between estradiol and VM is unclear and further studies are needed to clarify this association.

Reference

Tang B, Yu X, Jiang W, Zhang C, Zhan T, He Y. Clinical significance of serum sex hormones in postmenopausal women with vestibular migraine: potential role of estradiol. J Int Med Res. Published online May 22, 2021. doi:10.1177/03000605211016379