Ayca OZKUL, Hasibe Ozgecen DINCEL, Ali AKYOL

Cerebral Hemodynamic Response To Menstrual Cycle In Migraine

Objective: Menstrually related migraine (MRM) occurs in relation to menstrual cycles. We investigated the cerebral hemodynamic response to the menstrual cycle in nonmenstrually related migraines (nMRM), MRM and healthy controls. Methods: 22 nMRM, 20 MRM patients in an attack-free interval and 20 healthy volunteers were included in our study. TCD recordings were made during the follicular and luteal phases of the hormonal cycle and mean flow velocity values of middle and posterior cerebral arteries were studied. Cerebral vasomotor reactivity (CVR) was evaluated by breath holding index (BHI) and visually evoked blood flow (VEBF) changes in both phases of the same menstrual cycle. Results: Mean flow veloticities and hormone levels were not different between groups. Right BHI and bilateral VEBF values were significantly lower in both of the migraine groups. The physiological elevation of CVR in the luteal phase was detected in the control and nMRM groups, but not in the MRM group. Conclusion: The cerebral hemaodynamics were affected in both MRM and nMRM. Additionally the physiological CVR to menstrual cycle was impaired in MRM. The impairment in cerebral hemodynamic response to the menstrual cycle in MRM needs further research to discover the underlying pathophysiology.

Migrende Menstruel Siklusa Serebral Hemodinamik Yanıt

Giriş: Menstruasyon ilişkili migren (MİM) doğurganlık çağındaki kadınlarda menstruel siklus ile ilişkili belirir. Biz menstruel siklustaki serebral hemodinamik yanıtı menstruasyon ilişkli olmayan (nMIM), ve olan (MIM) migrenliler ve sağlıklı kontrollerde inceledik. Yöntemler: 22 nMIM, 20 MIM ataksız dönemdeki hasta ve 20 sağlıklı gönüllü çalışmamıza dahil edildi. Transkranial Doppler (TKD) kayıtları hormonal siklusun folikuler ve luteal fazlarında yapıldı ve orta ve posterior serebral arterlerin ortalama akım velositeleri çalışıldı. Serebral vazomotor reaktivite, breath holding index (BHI) ve visual evoked kan akımı (VEKA) değişiklikleri ile aynı menstruel siklus her iki fazında değerlendirildi. Bulgular: Ortalama akım velositeleri ve hormon seviyeleri gruplar arasında farklı değildi. Sağ BHI ve bilateral VEKA değerleri her iki migren grubunda belirgin düşüktü. Luteal fazdaki serebral vazomotoro reaktivite fizyolojik artışı kontrol ve nMIM gruplarda izlenirken MIM grubunda görülmedi. Sonuç: Serebral hemodinamikler hem MIM hem nMIM'de etkilenir. Ilaveten menstruel siklusta fizyolojik serebral vazomotor yanıt MIM'de bozulmuştur. MIM'de serebral hemodinamik yanıtın bozulması üzerine ileri çalışmalara alta yatan patofizyolojiyi keşfetmek için ihtiyaç vardır.

PDF

___

1. Klein E., Spencer D. Migraine frequency and risk of cardiovascular disease in women. Neurology. 2009; 73: 42–3.

2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013; 33: 629-808.

3. Brandes JL. Migraine in women. Continuum (Minneap Minn) 2012 Aug; 18: 835-52.

4. Allais G, Benedetto C. Update on menstrual migraine: from clinical aspects to therapeutical strategies Neurol Sci. 2004; 25: 229–31

5. Kurth T, Schürks M, Logroscino G, et al. Migraine frequency and risk of cardiovascular disease in women. Neurology. 2009 Aug 25; 73: 581-8.

6. Krejza J, Mariak Z, Huba M, et al. Effect of endogenous estrogen on blood flow through carotid arteries. Stroke. 2001; 32: 30–6.

7. Haring HP, Aichner F. Hemodynamic findings in migraine patients on transcranial Doppler sonography. Wien KlinWochenschr 1992; 104: 620- 5.

8. Zwetsloot CP, Caekebeke JF, Ferrari MD. Lack of asymmetry of middle cerebral artery blood velocity in unilateral migraine. Stroke. 1993; 24: 1335-8.

9. Nowak A, Kaciński M. Transcranial Doppler evaluation in migraineurs. Neurol Neurochir Pol. 2009 Mar-Apr; 43: 162-72.

10. Dora B, Balkan S. Exaggerated interictal cerebrovascular reactivity but normal blood flow velocities in migraine without aura. Cephalalgia. 2002May; 22: 288-90.

11. Totaro R, Marini C, De Matteis G, et al. Cerebrovascular reactivity in migraine during headache-free intervals. Cephalalgia 1997; 17: 191- 4.

12. Silvestrini M, Cupini LM, Troisi E, et al. Estimation of cerebrovascular reactivity in migraine without aura. Stroke. 1995; 26: 81-3.

13. Perko D, Pretnar-Oblak J, Sabovic M, et al. Cerebrovascular reactivity to L-arginine in the anterior and posterior cerebral circulation in migraine patients. Acta Neurol Scand. 2011 Oct; 124: 269-74.

14. Min JH, Kwon HM, Nam H. The effect of propranolol on cerebrovascularreactivity to visual stimulation in migraine. J Neurol Sci. 2011 Jun 15; 305: 136-8.

15. Granella F, Sances G, Allais G, et al.Characteristics of menstrual and nonmenstrual attacks in women with menstrually related migraine referred to headache centers. Cephalalgia. 2004; 24: 707Y716.

16. Welch KMA, Brandes JL, Berman N. Mismatch in how estrogen modulates molecular and neuronal function may explain menstrual migraine. Neurol Sci. 2006; 27: 190-2.

17. Pinkerman B, Holroyd K. Menstrual and nonmenstrual migraines differ in womenwith menstrually-related migraine. Cephalalgia. 2010 Oct; 30: 1187-94.

18. MacGregor EA, Victor TW, Hu X, et al. Characteristics of menstrual vs nonmenstrual migraine: A post hoc, within-women analysis of the usual-care phase of a nonrandomized menstrual migraine clinical trial. Headache. 2010; 50: 528–38.

19. Sacco S, Ricci S, Degan D, et al. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012 Apr; 13: 177-89.

20. Chrissobolis S, Budzyn K, Marley PD, et al. Evidence that estrogen suppresses rho-kinase function in the cerebral circulation in vivo. Stroke 2004; 35: 2200–05.

21. Hiroki J, Shimokawa H, Mukai Y, et al. Divergent effects of estrogen and nicotine on Rho-kinase expression in human coronary vascular smooth muscle cells. Biochem Biophys Res Commun. 2005; 326: 154–9.

22. Williams MR, Westerman RA, Kingwell BA, et al. Variations in endothelial function and arterial compliance during the menstrual cycle. J Clin Endocrinol Metab. 2001; 86: 5389 –95.

23. Kawano H, Motoyama T, Ohgushi M, etal. Menstrualcyclic variation of myocardial ischemia in premenopausal women with variant angina. Ann Intern Med. 2001 Dec 4; 135: 977-81.

24. Diomedi M, Cupini LM, Rizzato B, et al. Influence of physiologic oscillation of estrogens on cerebral hemodynamics. J Neurol Sci. 2001; 185: 49-53.

25. Krejza J, Mariak Z, Nowacka A, et al. Influence of 17-beta-estradiol on cerebrovascular impedance during menstrual cycle in women. J Neurol Sci. 2004; 221: 61–7.

26. Ibrahimi K, van Oosterhout WP, van Dorp W, et al. Reduced trigeminovascular cyclicity in patients with menstrually related migraine. Neurology. 2015 Jan 13; 84: 125-31.

27. Yücel Y. Migraine headache: Diagnostic and management approaches Dicle Med J. 2008; 35: 281- 6.