PATHOPHYSIOLOGICAL ASPECTS OF MENSTRUAL MIGRAINE

We review the role of several biochemical and hormonal factors in mens trual migraine pathogenesis: ovarian hormones. aldosterone circadian r hythm, nocturnal urinary melatonin excretion, sympathetic autonomic sy stem, prolactin levels and dopaminergic function, endogenous opioid to nus, platelet activity and arachidonic acid metabolites. In particular , we focus on certain aspects of platelet function and prostaglandin m etabolism, taking into consideration the different behavior of platele t sensitivity to prostacyclin, intraplatelet 5HT, peripheral plasma co ncentrations of 6-keto-PGF(1 alpha) and PGE(2) in menstrual migraine s ufferers and in control subjects during the menstrual cycle. A compreh ensive view of the data suggests that a complex impairment of PG and 5 HT metabolism, and of platelet function, may play a significant role i n the pathogenesis of menstrual migraine. However, it is not yet clear whether these alterations are primary or secondary to neuroendocrine disorders.