Ovarian hormones, age and pubertal development and their association with days of headache onset in girls with migraine: An observational cohort study. (April 2018)

• Record Type: Journal Article
• Authors: Martin, Vincent T; Allen, Janelle R; Houle, Timothy T; Powers, Scott W; Kabbouche, Marielle A; O'Brien, Hope L; Kacperski, Joanne; LeCates, Susan L; White, Shannon; Vaughan, Polly; Mandell, Karen; Hershey, Andrew D
• Is Part Of: Cephalalgia. Volume 38:Number 4(2018)
• Page Start: 707
• Page End: 717
• Publication Date: 2018-04
• Subjects: Migraine -- adolescence -- puberty -- ovarian hormones -- pubertal development -- menarche; Headache -- Periodicals; 616.8491
• DOI: 10.1177/0333102417706980
• Languages: English
• ISSNs: 0333-1024

Abstract

Background: Fifty-three percent of adolescent girls report headaches at the onset of menses, suggesting fluctuations of ovarian hormones trigger migraine during puberty. Aims: To determine if urinary metabolites of estrogen and progesterone are associated with days of headache onset (HO) or severity in girls with migraine. Methods: This was a pilot study and included 34 girls with migraine balanced across three age strata (pre-pubertal (8–11), pubertal (12–15), and post-pubertal (16–17) years of age). They collected daily urine samples and recorded the occurrence and severity of headache in a daily diary. Urine samples were assayed for estrone glucuronide (E1G) and pregnandiol glucuronide (PdG) and the daily change was calculated (ΔE1G, ΔPdG). Pubertal development was assessed by age, pubertal development score (PDS), and menstrual cycle variance. The primary outcome measures were HO days and headache severity. Generalized linear mixed models were used, and included the hormonal variables and three different representations of pubertal development as covariates. Results: Models of HO days demonstrate a significant age*PdG interaction (OR 0.85 [95% CI 0.75, 0.97]) for a 1 standard deviation increase in PdG and three-year increase in age. A separate model showed a significant PDS*PdG interaction (OR −0.85 [95% CI; 0.76, 0.95]). ΔPDG was associated with headache severity in unadjusted models ( p < 0.017). Conclusion: Age and pubertal development could moderate the effect of ovarian hormones on days of headache onset in girls with migraine.