Abstract
We described, about three years ago in Cephalalgia (1), a case titled ‘Menstrual paroxysmal hemicrania, a possible new entity?’ I would like to add further news about the history of the previously reported patient. In the following two years, the patient maintained the co-existence of paroxysmal hemicrania (PH) attacks, during the menstrual period (−2, +4), and migraine without aura about twice a month with the same clinical features in both, as it was in the past. After this time, the patient underwent a hysterectomy and bilateral ovariectomy for myomatosis and ovarian cysts. PH ceased immediately after surgery; however, migraine without aura persisted almost with the same attack recurrence but less severe in pain intensity. The situation is unchanged after 1-year follow-up.
This is further proof that supports hormonal correlation in PH attacks in this case as hypothesized in our previous communication (1). Moreover, it was reported in recent years that tension-type headache (2) and other rare or uncommon primary headache could be related to menstrual period, such as hemicrania continua (3) and nummular headache (4). These reports support the possible influence of hormonal changes as trigger factors, in a wide range of primary headaches and not only in migraine.
In fact, oestrogens have been linked to pain processing, through modulatory effects on γ-aminobutyric acid receptors, µ-opioid receptors, and nerve growth factor receptors in the dorsal root ganglion (5) and it is likely that sex steroid hormones influence the perception of a noxious stimulus at a variety of sites, from the peripheral nerve to the highest cortical responses (6).
Instead, actually, the diagnostic criteria for hormone-related headache are considered in the appendix to ICHD classification only for migraine (7). Further studies and reports are needed to clarify and understand the real dimension of the menstrual-related headache problem. It would be possible to achieve this result by including in the appendix of the next ICHD a chapter on this important topic.