18th European Headache Congress

Chair

Sex hormones and the hypothalamus

Professor

Invited speaker

Invited lecture

The influence of hormones throughout the migraine cycle

Overuse of analgesics can affect the fertility biomarker Anti-Müllerian hormone in females. A translational study

Medication overuse

Over-the-counter analgesics (OTC) have been associated with disrupted male endocrinology, while effects on female endocrinology remains nearly unknown. The aim was to understand the effect of long-term analgesic exposure in females with medication overuse headache (MOH) on Anti-Müllerian Hormone (AMH), a surrogate measure of female fertility.Using a translational approach, an observational prospective clinical study was conducted to determine AMH-levels in females with MOH, in combination with pre-clinical investigation of primary granulosa cells (GC) to understand the effects of analgesics on GC-function.We included 21 females (mean-age 30.0 years; SD (7.3)) for AMH-measurement. AMH increased by 21% from baseline (mean 20.1 pmol/L; SD (8.7)) after withdrawal of analgesics ((mean 24.3pmol/L; SD (12.0)); p=0.0023). Exposing primary GCs to analgesics (acetaminophen (100 and 200 µM, n = 9-10) and ibuprofen (150 and 200 µM, n = 12-13)) did not reduce AMH-levels. In contrast, de novo DNA synthesis in GCs (n=6) exposed to acetaminophen was reduced with 78% (p=0.0036) compared to controls, suggesting that cellular proliferation was restricted.Frequent use of OTC was associated with repressed AMH-levels likely through disruption of GC proliferation. Further research is crucial to investigate a potential effect of analgesics on adult female reproductive endocrinology.

Abstract lecture

Prof. Dr.

Sex differences in RAMP1/RAMP2 expression in the human middle meningeal artery match functional response to CGRP

Sex and gender

CGRP induces vasodilation after binding to the CGRP receptor (CLR-RAMP1), but can activate the adrenomedullin receptor (CLR-RAMP2) as well. Previously, age-dependent sex differences were observed for CGRP-induced relaxation of human middle meningeal arteries1. In addition, RAMP1 and RAMP2 mRNA expression was highly variable between patients2. The current study aims to investigate whether RAMP1 and RAMP2 expression differs between men and women and varies throughout life.RNA was isolated from homogenized human middle meningeal arteries (14 F, 12 M, age 51±3 years) and qPCR was performed for RAMP1 and RAMP2 mRNA expression. The ratio between RAMP1 and RAMP2 expression with increasing age was investigated for men and women separately.The RAMP1/RAMP2 ratio significantly decreases with age in men, while a positive trend can be observed for women. These findings match the pattern of maximum relaxation to CGRP as observed in a previous study1, with a significant decrease with age in men and a trend for increased maximum relaxation with age in women.The current study suggests that the maximum effect of CGRP-induced relaxation of human middle meningeal arteries matches the ratio of RAMP1/RAMP2 expression, and changes in a sex-dependent manner with increasing age. Interestingly, migraine is generally most prevalent in pre-menopausal women. Here, these young women show a relatively high RAMP2 and low RAMP1 expression, suggesting predominance of the adrenomedullin receptor over the canonical CGRP receptor in this population. Possibly, increased exposure of CGRP in young women results in downregulation of RAMP1. Future research should investigate whether RAMP1 and RAMP2 expression is altered in migraine patients.References1) de Vries T., Boucherie D. M., et al. 2024. Cephalalgia In Press2) de Vries T., Schutter D. et al. 2023. P200 European Headache Congress 2023, Barcelona, Spain.

Breakout room 2

Hormones and migraine, how do they interact?

Parallel session

Hormones and migraine, how do they interact?

Appointment

Chair

Programme