Hormonal susceptibility in migraine: A multimodal assessment across the menstrual cycle

• Applicant: Dr. Bianca Raffaelli
• Subject Area: Clinical Neurology; Neurosurgery and Neuroradiology
• Term: since 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 541952846

Migraine is a frequent and debilitating headache disorder that significantly affects women more often than men. Women not only experience migraine attacks more frequently but also with greater duration and intensity, particularly around the time of menstruation. The underlying reasons for these gender-specific differences are complex and not yet sufficiently understood. Fluctuations in sex hormones throughout the menstrual cycle may influence the susceptibility to migraine attacks, but the precise mechanisms and interactions remain unknown. Various factors play a role in the pathophysiology of migraine, including the activation of inflammatory pathways such as the Calcitonin Gene-Related Peptide (CGRP) pathway, (micro)vascular changes, and alterations in central brain excitability. The aim of this project is to characterize the interactions between sex hormones and various aspects of migraine pathophysiology in women during two distinct phases of the menstrual cycle: the perimenstrual phase, characterized by low estrogen levels, and the periovulatory phase, marked by high estrogen levels. The project consists of two studies. The first study involves the intravenous administration of CGRP to induce migraine attacks in women with migraine during different phases of the menstrual cycle. It is a double-blind, placebo-controlled study with a crossover design. The second study examines a wide range of (micro)vascular parameters during both menstrual cycle phases, including endothelial microparticles, changes in dermal blood flow after local hyperemia, and arterial stiffness. Additionally, changes in brainstem excitability are measured using the nociceptive blink reflex. Overall, this project aims to enhance our understanding of the interactions between sex hormones and migraine pathophysiology in women during various phases of the menstrual cycle. Given the substantial burden of migraine on women of reproductive age, it is high time to address these research gaps. The studies presented in this project contribute to achieving this through a hypothesis-driven approach and diverse methods and study designs.

• DFG Programme: Research Grants
• Major Instrumentation: Laser Speckle Perfusion Imager (LSPI)
• Instrumentation Group: 3010 Blutdurchflußmeßgeräte