Migraine is ranked as the second highest cause of disability worldwide and the first among women aged 15–49 years. Overall, the incidence of migraine is threefold higher among women than men, though the frequency and severity of attacks varies during puberty, the menstrual cycle, pregnancy, the postpartum period and menopause. Reproductive hormones are clearly a key influence in the susceptibility of women to migraine. A fall in plasma oestrogen levels can trigger attacks of migraine without aura, whereas higher oestrogen levels seem to be protective. The basis of these effects is unknown. In this Review, we discuss what is known about sex hormones and their receptors in migraine-related areas in the CNS and the peripheral trigeminovascular pathway. We consider the actions of oestrogen via its multiple receptor subtypes and the involvement of oxytocin, which has been shown to prevent migraine attacks. We also discuss possible interactions of these hormones with the calcitonin gene-related peptide (CGRP) system in light of the success of anti-CGRP treatments. We propose a simple model to explain the hormone withdrawal trigger in menstrual migraine, which could provide a foundation for improved management and therapy for hormone-related migraine in women.

偏头痛被列为全球第二大残疾原因，在 15-49 岁的女性中排名第一。总体而言，女性偏头痛的发病率是男性的三倍，尽管偏头痛发作的频率和严重程度在青春期、月经周期、怀孕、产后和更年期各不相同。生殖激素显然是影响女性偏头痛易感性的关键因素。血浆雌激素水平下降可引发无先兆偏头痛发作，而较高的雌激素水平似乎具有保护作用。这些影响的基础是未知的。在这篇综述中，我们讨论了对中枢神经系统偏头痛相关区域和外周三叉神经通路中性激素及其受体的了解。我们通过其多种受体亚型和催产素的参与来考虑雌激素的作用，催产素已被证明可以预防偏头痛发作。鉴于抗 CGRP 治疗的成功，我们还讨论了这些激素与降钙素基因相关肽 (CGRP) 系统的可能相互作用。我们提出了一个简单的模型来解释月经性偏头痛的激素戒断触发因素，这可以为改善女性激素相关偏头痛的管理和治疗奠定基础。