A recent study published in Cephalgia tried to determine if hormone levels in urine were associated with days of headache onset or HO (days with an onset of a headache after observing a day without a headache) and #headache severity in pre-pubertal, pubertal, and post-pubertal girls with migraine https://www.ncbi.nlm.nih.gov/pubmed/28474986.

RESULTS: The results of this study were very interesting. Estrogen levels did not have an effect on headache days. The effect of progesterone varied depending on age. For girls aged 8-11, higher progesterone levels were associated with higher levels of headache onset days. There was little to no progesterone effect for girls aged 12-15. Higher levels of progesterone were associated with a decreased number of HO days in females 16-17 years of age.

CONCLUSIONS: Altogether, these results suggest that elevated levels of progesterone and its derivatives are associated with high HO before menarche (the first occurrence of menstruation) and a decreased occurrence of HO after menarche. The pattern found in females after menarche is consistent with that of adult women. Headaches have been found to be lowest during the mid-luteal phase of the menstrual cycle which is associated with higher progesterone levels.

The authors gave some possible reasons for the different response related to progesterone among age groups. Allopregnanolone, a metabolite of progesterone, interacts with the GABA-A receptor (a receptor found in the central nervous system). There is evidence in animal studies that this receptor changes at the time of puberty. Perhaps the effects of progesterone seen in this study could have been mediated through this receptor.

The most surprising finding in this paper was that estrogen had no association with headache onset at all. Dropping estrogen levels have long been considered to be the culprit in menstrual migraine, so it seems reasonable that estrogen would be at least partially to blame for migraines during puberty. The authors postulated that perhaps girls in this age category do not have high enough estrogen levels during their menstrual cycles to attain a rate of decline that causes migraines.

This study didn’t exactly change anything for the average young migraine patient since no one really knows their own hormone levels from day to day. But it did make it clear how complicated the contribution of hormones are to migraine symptoms in young people during puberty. The findings were novel and interesting and I’m always excited to see people working in the area of hormones and migraine. It’s even more exciting when researchers are studying adolescent #migraine.