Emicrania e ormoni gonadici femminili: Implicazioni per il sistema nervoso centrale

Migraine is a disorder typically associated with female reproductive life. It is regarded as a 'female disease' not only on the basis of the pattern of its prevalence, but also to the neuroendocrine changes related to reproductive life and possible hormonal treatments (oral contraceptives, estrogen replacement therapy) can considerably affect the clinical presentation and the natural course of the disorder. Numerous studies have been focused on the relationship between migraine and hormones, from both the pathophysiological and the clinico-epidemiological perspectives. However, no conclusive evidence is available to date on the role of hormone fluctuations in triggering pain attacks. Menstrual migraine, for instance, is a paradigm of such changes, but to explain the phenomenon of migrainous vulnerability in this definite period of the ovarian cycle it is necessary to take into account the interaction of several steroid-dependent mechanisms, both neuronal and vascular. In this short review we discuss some aspects supporting the existence of a close relationship between gonadal steroids and mechanisms of migraine within the central nervous system (CNS) of female patients. Particular emphasis is placed on the events of reproductive life and hormonal treatments, and on the usefulness of an integrated approach by neurologists and gynaecologists in the management of migraine in woman.