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Reduced trigeminovascular cyclicity in patients with menstrually related migraine.

Neurology (2014-12-17)
Khatera Ibrahimi, Willebrordus Petrus Johannes van Oosterhout, Wendy van Dorp, A H Jan Danser, Ingrid M Garrelds, Steven A Kushner, Emmanuel M E H Lesaffre, G M Terwindt, Michel D Ferrari, Anton H van den Meiracker, Antoinette MaassenVanDenBrink
ABSTRACT

A case-control study to investigate the effect of the menstrual cycle on trigeminal nerve-induced vasodilation in healthy women and patients with menstrually related migraine (MRM). Using a laser-Doppler imager, we compared the vasodilator effects of capsaicin application and electrical stimulation (ES) on the forehead skin, a trigeminal nerve-innervated dermatome, in premenopausal patients with MRM (n = 22), healthy controls (n = 20), and postmenopausal women without migraine (n = 22). Blood samples were collected for female sex hormone measurements. Dermal blood flow (DBF) responses to capsaicin were higher in controls during days 1-2 than during days 19-21 of their menstruation cycle (mean Emax ± SEM: 203 ± 28 AU vs 156 ± 27 AU [p = 0.031] for 0.06 mg/mL capsaicin and 497 ± 25 AU vs 456 ± 24 AU [p = 0.009] for 6.0 mg/mL capsaicin). In contrast, patients with MRM demonstrated DBF responses without significant cycle-dependent variability (days 1-2 vs days 19-21: Emax 148 ± 20 AU vs 154 ± 20 AU [p = 0.788] for 0.06 mg/mL capsaicin and 470 ± 17 AU vs 465 ± 20 AU [p = 0.679] for 6.0 mg/mL capsaicin). DBF responses to ES were not different between either patients with MRM or controls, at either occasion. Estradiol levels on days 19-21 of the menstrual cycle were higher in healthy controls (mean ± SEM: 75 ± 8 pg/mL) than in patients with MRM (52 ± 4 pg/mL, p = 0.014). In postmenopausal women, DBF responses to capsaicin and ES, as well as estradiol levels at both visits, were all significantly reduced compared to patients with MRM and controls (in all cases, p < 0.05). Our study provides evidence for a reduced menstrual cyclicity of both estradiol levels and the trigeminovascular vasodilator system in patients with MRM.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Progesterone, ≥99%
Sigma-Aldrich
Progesterone, powder, BioReagent, suitable for cell culture
Sigma-Aldrich
Estradiol, meets USP testing specifications
Sigma-Aldrich
Bicinchoninic acid disodium salt hydrate, ≥98% (HPLC)
Supelco
Estradiol, Pharmaceutical Secondary Standard; Certified Reference Material
Supelco
Progesterone, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Progesterone, γ-irradiated, BioXtra, suitable for cell culture
Sigma-Aldrich
Progesterone, meets USP testing specifications
USP
Estradiol, United States Pharmacopeia (USP) Reference Standard
USP
Progesterone, United States Pharmacopeia (USP) Reference Standard
Supelco
Progesterone, VETRANAL®, analytical standard
Progesterone for system suitability, European Pharmacopoeia (EP) Reference Standard
Progesterone for peak identification, European Pharmacopoeia (EP) Reference Standard
Progesterone, European Pharmacopoeia (EP) Reference Standard