Download Treatment of Migraine in Pre and Post

1|Responsible Patienthood Assignment: Human Biology
Quaitie Siverly
February 28, 2013
Treatment of Migraine in Pre and Post-Menopausal Women
Siverly, Quaitie Please include your name and RP1 and date
A migraine headache presents with intense throbbing or pulsing in one area of the head and is
commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Migraine attacks can last for hours or days. Migraine headaches often begin in childhood,
adolescence, or early adulthood, and migraine headaches in females are associated with
hormonal changes (Mayo Clinic, 2012). Some migraines are preceded or accompanied by
sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in arms or legs
(Mayo Clinic, 2012).
Chronic migraine headaches progress from episodes of migraine without aura. Diagnosis of
chronic migraine includes the following:
 Affects only one side of the head
 Cause a pulsating, throbbing sensation
 Cause moderate to severe pain
 Are aggravated by routine physical activity (Mayo Clinic, 2012).
They also cause at least one of the following:
 Nausea, vomiting or both
 Sensitivity to light and sound (Mayo Clinic, 2012).
The causes of migraine are not completely understood by medical professionals, however, there
are common symptoms among patients; genetics and environmental factors (both relate to
migraine attacks). In particular, and relative to the subject of this paper, hormonal changes in
women are also related to migraine symptoms (Mayo Clinic, 2012).
In pre and post-menopausal women, migraine frequency and intensity can improve or get worse.
Pre-menopause is defined by irregular periods, and post-menopause is defined by the time period
in which a woman has not had a period for 12 months (Mayo Clinic, 2012). While migraine
occurrence has shown a decrease in both males and females with advancing age, menopausal
changes in some women can cause migraines to intensify (Nappi, et al., 2001:158). This is
related to the erratic estrogen secretion and unbalanced estrogen exposure due to anovulatory
cycles (a cycle in which the ovaries do not release an egg cell) and/or progesterone deficiency
during the perimenopausal period (Nappi, et al., 2001:158).
Migraine headaches occur in 18% of the female population with peak occurrences during 35-45
years of age, and with 47% of women having menstrual migraine (migraines that occur during
the premenstrual time-period of 2 days before or 3 days after onset) (Glaser, et al., 2012:385).
Testosterone is a neuroactive steroid shown to have positive effects in the prevention of
headaches by increasing the serotonin levels, and it is effective both as an anti-inflammatory and
neuro-protective; mechanisms that may protect against migraines (Glaser, et al., 2012:388). Data
2|Responsible Patienthood Assignment: Human Biology
Quaitie Siverly
February 28, 2013
shows that fluctuations in ovarian hormones are responsible for triggering migraine headache in
susceptible women due to declining serum levels of estrogen (Glaser, et al., 2012:385).
Testosterone has a wide range of biological effects in pre- and post-menopausal women; partly a
result of widespread androgen receptors, including those in the ovaries. Androgens are the
natural testosterone in women that are produced in the ovaries, adrenal glands and fat cells, and
androgen production declines in women gradually throughout their reproductive years. By age
40, a woman has half the testosterone as a woman age 21 (Glaser, et al., 2012:385).
Testosterone implants have been safely used in women since 1938, and until recently was the
only licensed form of testosterone for women in England (Glaser, et al., 2012:385). The positive
outcomes from recent studies which focused on testosterone therapy in pre- and post-menopausal
women for androgen deficiency, initiated the testosterone pilot study for women with a migraine
history (Glaser, et al., 2012:385). This deficiency, relative to women with a history of migraine
headache, was studied to determine the therapeutic effects of continuous testosterone delivered
to 27 pre- and post-menopausal women. The intent of the study was to determine if there is an
improvement in migraine headache severity using a scale of 1-5 as a baseline prior to therapy,
and again three months following with treatment of the testosterone implants (Glaser, et al.,
2012:385). The patients in the study were either self-referred or referred by their physician with
reported symptoms of androgen deficiency related to menopause including: hot flashes, sleep
disturbances, depressive mood, anxiety, irritability, physical fatigue, impaired memory, chronic
pain, urinary problems and vaginal dryness (Glaser, et al., 2012:387), with a chief complaint of
migraine headache. Of the 27 patients who were previously diagnosed with migraine headache,
16 were pre-menopausal; age range of 31-52, and 11 were post-menopausal; age range of 45-79
(Glaser, et al., 2012). The study noted that the prevalence of migraine headaches in females age
35-40 coincides with declining testosterone levels (Glaser, et al., 2012:387).
Upon arrival at the pilot study, the women were asked to rate their headaches using a 5-point
rating scale of severity: none 0, mild 1, moderate 2, severe 3, or extremely severe 4 (Glaser, et
al., 2012:387). The twenty-seven patients received their first dose of testosterone pellet inserts
between June 2009 and March 2010 (Glaser, et al., 2012:387).
Three months later, the women were asked again to rate the severity of their migraines following
the use of testosterone therapy (Glaser, et al., 2012:387). The testosterone treatment was
administered as follows: 130 ± 19.7 mg (range 100-160 mg) of testosterone, which was delivered
subcutaneously (under the skin) in a sustained release pellet implant (Glaser, et al., 2012:387).
The results of the study reflect that 74% of the patients reported a headache severity score of ‘0’
(zero) while on implant therapy for three months (Glaser, et al., 2012:385). The data chart noted
the participants ages, medication used prior to the testosterone implantation, headache frequency
and severity, and severity score while on testosterone therapy. The breakdown of the data reflects
the following (Glaser, et al., 2012:387):
3|Responsible Patienthood Assignment: Human Biology
Quaitie Siverly
February 28, 2013


Of the16 pre-menopause participants, 11 reported a ‘0’ (zero) score with no use of
medications while on testosterone therapy.
Of the 11 post-menopause participants, 8 reported a ‘0’ score with no use of medications
while on testosterone therapy.
The study also reports that of the 27 patients on the testosterone implant study, there were no
adverse reactions to the therapy (Glaser, et al., 2012:387).
Initially, the 27 patients who participated in the study had also related symptoms of androgen
deficiency and a poorer quality of life (as measured by the Menopause Rating Scale), and while
using the testosterone implant, they reported a decrease in these symptoms. This supports the
benefits of testosterone therapy for pre and post-menopause symptoms other than migraine.
Another supporting factor is found in the following: 25 of the 27 patients returned three months
after the study for a second implant, with results reflecting benefits in relief of migraine
symptoms. 20 patients reported a ‘0’ score (no migraine) for ten or more weeks following the
second implant (Glaser, et al., 2012:386-87).
The same testosterone implant was used in a 2011 study to determine if the therapy is beneficial
to women in relieving the somatic, psychological and urogenital symptoms of pre and postmenopause, and concluded that the use of the implant was effective for the relief of hormone
deficiency symptoms (Glaser, et al., 2011:355). Comparable to the 2012 study, the same was
reported in the 2011 study: there were no adverse reactions to the testosterone. Provide actual
data where it is available.
Despite testosterone implant benefits, it was noted that long-term studies are needed to further
document the efficacy and safety of testosterone therapy in women (Glaser, et al., 2011:360).
Also, the study of the testosterone implant used on the 27 migraine patients reported two major
weaknesses: a non-validated scale to measure severity of migraine symptoms, and no control
group study was conducted to compare the data. However, since the data revealed that the
majority of the patients reported no headache with no medication use for three months, it was
concluded that the benefits speak against the weaknesses aforementioned (Glaser, et al.,
2012:388).
Based on the material provided, and in conjunction with the benefits of migraine relief along
with hormone deficiency relief, it is my opinion that testosterone implant treatment is successful,
As a result of the research conducted for this paper, I add the following: I am a 53-year-old
woman who has been treated for chronic migraines beginning at age 18. Since the onset of postmenopause at age 45, my migraines have increased in both frequency and intensity. Using the
new information I’ve gained, I am more confident in advocating for myself, and intend to
become a responsible patient by discussing options of testosterone therapy with my family
practitioner.
4|Responsible Patienthood Assignment: Human Biology
Quaitie Siverly
February 28, 2013
References:
Glaser, R., Dimitrakakis, C., Trimble, N., & Martin, V. (2012). Testosterone pellet implants and
migraine headaches: a pilot study. Maturitas, 71(4), 385-388.
doi:10.1016/j.maturitas.2012.01.006
Glaser, R., York, A., & Dimitrakakis, C. (2011). Beneficial effects of testosterone therapy in
women measured by the validated Menopause Rating Scale (MRS). Maturitas, 68(4),
355-361. doi:10.1016/j.maturitas.2010.12.001
Mayo Clinic, 2012. Migraine Definition. http://www.mayoclinic.com/health/migraineheadache/DS001 Retrieved February 18, 2013
Nappi, R., Cagnacci, A., Granella, F., Piccinini, F., Polatti, F., & Facchinetti, F. (2001). Course
of primary headaches during hormone replacement therapy. Maturitas, 38(2), 157-163.
The essays are scored as follows:
10 = Publishable and professional (rarely given)
9 = Excellent and thorough and clear
8 = Very good coverage of the material
7= Adequate coverage of the material
6 = Inadequate
Jerry Woolpy
[email protected]
Response to my email regarding the header and my score:
You got a perfect score. A+ Sorry I missed the header.
J