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Expert Review of Neurotherapeutics Volume 21, 2021 - Issue 12
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Perspective

Hormonal therapies in migraine management: current perspectives on patient selection and risk management

Enrico Bentivegnaa Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy;b Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, ItalyCorrespondence[email protected]
ORCID Iconhttps://orcid.org/0000-0001-6655-9905
ORCID Icon,
Michelangelo Luciania Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy;b Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, ItalyORCID Iconhttps://orcid.org/0000-0002-6038-8874
ORCID Icon,
Francesco Scarsoa Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy;b Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
,
Clara Brusciaa Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy;b Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
,
Dario Chiappinoa Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy;b Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
,
Emanuele Amorea Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy;b Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
,
Gabriele Nallia Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy;b Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
&
Paolo Martellettia Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy;b Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, ItalyORCID Iconhttps://orcid.org/0000-0002-6556-4128
ORCID Icon show all
Pages 1347-1355 | Received 03 Aug 2021, Accepted 04 Nov 2021, Published online: 25 Nov 2021
 
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ABSTRACT

Introduction

The link between sex hormones and migraines has long been investigated but the mechanisms underlying this altered interaction are not yet fully understood. Herein, we retrace the knowledge on this association in relationship with risk of stroke.

Areas covered

Estrogens fluctuations could trigger migraine attacks and exogenous estrogens intake could be a risk factor for venous thromboembolism (VTE) and stroke. At the same time, ischemic heart diseases and stroke share a common substrate with migraine and other mood disorders, depression, and anxiety.

Expert opinion

The use of hormonal therapies in the context of contraception or replacement therapy must be closely evaluated in a careful risk assessment. We highlight the complex interaction of hormone/neuroinflammation pathways underlying the pathophysiology of migraine glimpsing in mood disorders a possible common denominator of link between hormonal and neuronal systems.

Funding

This paper was not funded.

Article highlights

  • Estrogens fluctuations could trigger migraine attacks and estrogens intake is a risk factors for developing stroke.

  • Depression, anxiety, ischemic heart diseases, and stroke share a common substrate with migraine.

  • Migraine is the complex result of an interaction of several pathways and hormone/neuroinflammation link seems to play a central role.

  • It would be important to focus on the behavioral mood that characterizes this altered relationship.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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