Relationships between cerebrovascular function and the incidence and severity of headache in premenopausal women

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Migraine is an episodic primary headache disorder, affecting 10% of adults with varying degree of disability that can interfere with daily living. The prevalence of migraine is 2 to 3 times greater in women than in men, particularly during reproductive years; peaking between 30 and 39 years of age and a second peak around 50 years old (onset of menopause). It is estimated that migraine attacks related to menstruation occur in 35-51% of women and are associated with the fall of estrogen levels (~2 days before menses) and may continue for a few more days until estrogen levels rise again. There is growing appreciation of the link between migraine and heightened risk of vascular diseases, particularly for stroke. In fact, studies have shown that women with migraine, especially with aura, are at twice the risk for ischemic stroke. We want to characterise any circulatory abnormalities in the brain in women who suffer from menstrual migraine. In this study, we will measure the flow of blood in the brain in premenopausal women and compare those who suffer from menstrual migraine with those who are not susceptible. We will also explore the role of blood pressure, differences in gene expression, stiffness of blood vessels, and the effects of menstrual migraine on quality of life and mental performance. We aim to see whether abnormalities of blood flow in the brain may predispose women to menstrual migraine and to see whether these abnormalities are associated with differences in gene expression between those who suffer from menstrual migraine and those who are not susceptible. This information will help us to design more effective interventions to counteract migraine.