A study published in Neurology shows a correlation between the drop in estrogen levels during the ovulatory phase and a greater release of CGRP, one of the most powerful endogenous vasodilators, present in tears
In the tears of women with migraines hides the secret why headache attacks that occur during menstruation are the most painful. It is known that in the ovulatory phase, which elapses between menstruation, the level of estrogen fluctuates and is highest in the follicular phase in which the uterus prepares to welcome the egg. It is also known that the periodic decline of this hormone causes an exacerbation of the attacks in migraineurs. What was not known was why.
CGRP
They were to find out
the researchers of the University of Berlin directed by Bianca Raffaelli
in one study of 140 women just published in Neurology: il decrease in estrogen causes increased release of CGRPacronym of Calcitonine Gene Related Peptide, i.e. peptide related to the calcitonin gene, one of the most powerful endogenous vasodilators known and now considered the main trigger of migraine
and towards which the most recent ones have in fact been directed monoclonal antimigraine drugs that block it, nipping the headache in the bud.
Analysis of tears
But that’s not all: German researchers have also devised a simple, non-invasive and effective method to check
i CGRP levels hitherto elusive to controls by blood where it degrades easily by losing its traces. They actually went looking for him
in tears where it does not have time to get lost both because the lacrimal gland is closest to the trigeminal nucleus where it is mainly produced, and because the technical times for tear analysis are faster than those of blood.
Origin of migraine
The discovery will be useful to verify the nature of the headache of the woman who has always been the subject of discussion: themenstrual migraine, which insiders call catamenial, not yet unequivocally framed. Menstruation is a triggering factor in over 50% of patients, but they are the exclusive factor in only 9-10% of cases. Catamenial migraine occurs only in the peri-menstrual period with a maximum incidence between the 2 days preceding and 3 days following the onset of the cycle. Moreover also 30% of women affected by the most common form of migrainethat is, the one without aura, presents attacks associated with the menstrual cycle which are often more intense and lastingcausing greater disability than those that occur outside of this period.
The less estrogen, the more pain
Before the hormonal stabilization that occurs in later life, when most women finally find a long break from pain, the frequency and severity of migraine attacks related to the decrease in plasma estrogen concentrations are greater during the perimenstrual phase or in perimenopause period.
Migraine affects women more
Once validated, the method of tears can also be used to verify the efficacy of the anti-migraine treatment over time. In fact, if in the phases of estrogenic decrease the tear level of CGRP will not rise, the non-appearance of the usual headache will not be accidental, but the confirmation of the efficacy of the therapy which will no longer have only a clinical confirmation, but also a laboratory one. A completely new occurrence in a disease where there are very few laboratory data. Migraine affects women much more than men, with a ratio of at least 3 to 1 during childbearing age, says Giovanni Battista Allais, Head of the Women’s Headache Center at the University of Turin. Before this study, we mostly had data from animal research, however partial, and not from direct surveys on women.
The German colleagues, on the other hand, checked groups of migraine and non-migraine sufferers, in various hormonal conditions (ie in a fertile cycle) and with the assumption of combined estrogen-progestin oral contraceptives, or in menopause. For the first time they have offered a comparison of how estrogen and CGRP rates behave in these three situations, so different from a hormonal point of view, explains the expert.
To each its own CGRP
The study evaluated 180 women with episodic migraine divided into 6 groups of 30: one for those with a normal cycle, another for those taking contraceptives and one for menopausal women. As controls, there were three groups of non-migraineur women who were homogenous to those with migraineurs in age and characteristics. During menses, the concentrations of CGRP in the tears of regularly cycling migraineurs were higherwhile in those taking contraceptives or were postmenopausal they were similar whether they were migraineurs or non-migraineurs.
Tear collectors
The tears were collected in 4 ml tubes from the corner of the eye on the side where migraine pain was most frequently manifested and in case a migraine laterality was missing, the right side was chosen, also used for non-migraine-prone women.
Il canto the right or left corner of the eye where the upper and lower eyelids meet. The medial chantthe closest to the nose, the one from which we most often see tears flow.
More than a tear on the face
A limitation of the test is the lack of tear production for over a minute in order to avoid the degradation of the CGRP, but a Dutch study by the University of Tilburg reassures us that, always p
for hormonal reasons attributable to prolactin, women cry at least 30% more than men and therefore there is good hope for widespread use of this test in migraines.
February 24, 2023 (change February 24, 2023 | 11:29 am)
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