Female-selective mechanisms promoting migraine

Shagun Singh, Caroline M. Kopruszinski, Moe Watanabe, David W. Dodick, Edita Navratilova, Frank Porreca

Research output: Contribution to journalReview articlepeer-review

Abstract

Sexual dimorphism has been revealed for many neurological disorders including chronic pain. Prelicinal studies and post-mortem analyses from male and female human donors reveal sexual dimorphism of nociceptors at transcript, protein and functional levels suggesting different mechanisms that may promote pain in men and women. Migraine is a common female-prevalent neurological disorder that is characterized by painful and debilitating headache. Prolactin is a neurohormone that circulates at higher levels in females and that has been implicated clinically in migraine. Prolactin sensitizes sensory neurons from female mice, non-human primates and humans revealing a female-selective pain mechanism that is conserved evolutionarily and likely translationally relevant. Prolactin produces female-selective migraine-like pain behaviors in rodents and enhances the release of calcitonin gene-related peptide (CGRP), a neurotransmitter that is causal in promoting migraine in many patients. CGRP, like prolactin, produces female-selective migraine-like pain behaviors. Consistent with these observations, publicly available clinical data indicate that small molecule CGRP-receptor antagonists are preferentially effective in treatment of acute migraine therapy in women. Collectively, these observations support the conclusion of qualitative sex differences promoting migraine pain providing the opportunity to tailor therapies based on patient sex for improved outcomes. Additionally, patient sex should be considered in design of clinical trials for migraine as well as for pain and reassessment of past trials may be warranted.

Original languageEnglish (US)
Article number63
JournalJournal of Headache and Pain
Volume25
Issue number1
DOIs
StatePublished - Dec 2024

Keywords

  • Calcitonin gene related peptide
  • Gepants
  • Migraine
  • Nociceptor
  • Pain
  • Prolactin
  • Sexual dimorphism

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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