Cleo Handtmann (Berlin, DE), Mira Pauline Fitzek (Berlin, DE), Lucas Hendrik Overeem (Berlin, DE), Uwe Reuter (Berlin, DE; Greifswald, DE), Bianca Raffaelli (Berlin, DE)
Sex hormone fluctuations are discussed as triggers for migraine attacks, with past research focusing on estrogen levels ("estrogen withdrawal hypothesis"). However, the evidence supporting this hypothesis is limited and often conflicted, indicating that estrogen withdrawal alone may not fully explain the phenomenon. Recent interest has shifted towards other hormones such as oxytocin. Oxytocin modulates the trigeminovascular system and vascular tone, exhibits analgesic properties, and interacts with the calcitonin-gene related peptide (CGRP) signaling pathway. Oxytocin levels fluctuate in parallel with estrogen, suggesting that drops in both hormones may increase migraine frequency. Thus, blocking oxytocin receptors (OTR) could help investigate the impact of oxytocin withdrawal on migraine.
This study is a monocentric, double-blind, randomized, placebo-controlled, cross-over human provocation study, utilizing the OTR antagonist atosiban as the provocation substance (DRK00033341). We hypothesize that inhibiting the effect of oxytocin through receptor antagonization will lead to migraine attacks in women with migraine. Secondary endpoints include analyses of vascular parameters and CGRP concentrations. The study began in February 2024 and will enroll 20 female patients with episodic migraine. Key inclusion criteria include continuous hormonal contraception (to maintain stable sex hormone levels), 1-5 monthly migraine days, and no daily medication intake.
not applicable
The immediate significance of this research lies in enhancing our understanding of oxytocin"s role in migraine pathophysiology and its interaction with the vascular system and the CGRP pathway. If OTR blockade under stable estrogen levels induces migraine attacks, it could challenge the estrogen withdrawal hypothesis. Ultimately, these findings could lead to new therapeutic applications, emphasizing the importance of oxytocin in migraine treatment.
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