title: Migraine: is it related to hormonal disturbances or stress?
abstract: BACKGROUND
  Common neurological syndrome (migraine without aura) is more common among women than men. Migraine is among the top 20 causes of disability. Menstruation is known to be a powerful trigger for migraine, and so is stress, but the presentation of headache is similar in both. Also, women are more vulnerable to stress as well as migraine, and this makes a complex relationship of menstruation, stress, and migraine.
  
  
  OBJECTIVE
  This study was done to understand the association of hormonal fluctuation in menstruation and stress with common migraine.
  
  
  METHODS
  A cross-sectional comparative study was conducted in 40 young adult females, of whom 20 participants were cases of migraine without aura (18-35 years old), and the remaining 20 participants were age-matched controls. The study was done in Maulana Azad Medical College, New Delhi. Study participants were selected on the basis of International Headache Society (ICHD-IIA1.1) (2004) classification. Study participants with neurological disorders, chronic diseases, and disease suggestive of any hormonal disturbances were excluded. Clinically diagnosed migraine cases were asked to maintain a headache diary and to fill in the Depression Anxiety Stress Scales questionnaire. Biochemical assessment of hormonal status for thyroid-stimulating hormone, triiodothyronine, thyroxine, estrogen, follicle-stimulating hormone, luteinizing hormone, and prolactin was also done on the second day of their menstrual cycle. We used the Mann-Whitney U test to compare hormonal levels and the χ (2) test to compare anxiety- or depression-related stress among the migraine and nonmigraine groups.
  
  
  RESULTS
  Significantly higher values of prolactin were observed in cases (mean ± standard deviation, 152.7 mIU/L±30.5) compared to controls (76.1 mIU/L±8.7), with a P-value <0.001. There was no statistically significant difference observed in levels of thyroid-stimulating hormone (P=0.081), estrogen (P=0.086), luteinizing hormone (P=0.091), or follicle-stimulating hormone (P=0.478). Also, anxiety with stress or depression with stress was significantly higher among the migraine group than the controls (P=0.002). Odds of any stress in migraine were higher in the migraine group than in the nonmigraine group (odds ratio 12, 95% confidence interval 2.7-53.33).
  
  
  CONCLUSIONS
  Migraine, particularly without aura, in women is mainly associated with stress-related anxiety or depression, and are more susceptible to stress in the premenstrual period.
authors.affiliation: Department of Physiology, All India Institute of Medical Sciences, Bhopal, India.
authors.forename: Rachna
authors.initials: R
authors.lastname: Parashar
authors.affiliation: Department of Physiology, Vardhaman Mahavir Medical College, New Delhi, India.
authors.forename: Payal
authors.initials: P
authors.lastname: Bhalla
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, Bhopal, India.
authors.forename: Nirendra K
authors.initials: NK
authors.lastname: Rai
authors.affiliation: Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Pakhare
authors.affiliation: Department of Physiology, Maulana Azad Medical College, New Delhi, India.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Babbar
keywords: menstruation; migraine; stress