18 Chapter 1 Influence of sex hormones Despite the well-recognized epidemiological relationship between sex hormones and migraine in women, the specific mechanisms by which hormonal factors influence migraine susceptibility are still insufficiently understood. It is hypothesized that the sudden drop in estradiol prior to menses lowers the threshold for an upcoming migraine attack,24-26 but there is still poor understanding of the exact underlying pathophysiological mechanism of menstrual migraine. Fluctuations in estradiol are Figure 4. Influence of CGRP and the different oestrogen receptors: oestrogen receptor-alpha (ERα), oestrogen receptor-beta (ERβ), and the G-protein-coupled oestrogen receptor (GPER). PAG = periaqueductal grey; LC = locus coeruleus; TNC = trigeminal nucleus caudalis; TG = trigeminal ganglion.
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