According to a new study from researchers at University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, hormonal changes could activate headaches in young girls, but their impact may depend on age and their stage of pubertal growth.

Dr. Vincent Martin, MD, professor in the UC Division of General Internal Medicine and co-director of the Headache and Facial Pain Center at the UC Gardner Neuroscience Institute believes that this was the first study to confirm that migraine headaches can also be affected by female hormones in young girls with migraine. The scientists in this study noted progesterone to be the major trigger factor in adolescent girls with migraine. However, the effect could vary based on age and their stage of pubertal growth.

According to the Migraine Research Foundation (MRF), about 10% of school-age children suffer from migraine. Also, the incidence of migraine multiplies rapidly in girls as adolescence approaches, and by the age of 17, about 8% boys and 23% girls have experienced migraine.

Martin explains that the previous studies have shown female hormones as an important contributor to migraine in adult women. Two-third of adult women will develop migraine attacks, which can develop before or at the time of menstrual bleeding. These attacks are known as "menstrual migraine. Menstrual migraine is often triggered due to decreasing levels of estrogen. Before this study, the interference of female hormones on migraine was not clear in girls and at what age this might occur.

According to Martin, there has been a drastic change in the way that female hormones affect migraine that occurs during puberty. Before puberty, progesterone has little effect on migraine. After puberty, high progesterone levels are linked with fewer headaches, and low progesterone levels have more headache."

During this 13-month study, the researcher examined 34 girls experiencing migraine distributed across three age levels, ages 8-11, 12-15 and 16-17. Daily urine samples were collected, and the appearance and severity of headaches were recorded in the diary for a 90-day period. Evaluation of urine samples was done for metabolites of the sex hormones (estrogen and progesterone). It helped to find out whether their presence was associated with days of headache onset or severity.

The study revealed that high levels of progesterone were associated with reduced frequency of headaches in older teens. Martin explained that in 16-17 age group, there were 42% chances of having a headache when levels of progesterone were low in urine samples, and the chance of headache dropped to 24% when the levels of the hormone were higher. There were 15% chances of suffering from migraine or headache when levels of progesterone were low, in the age group of 8 to 11. But 20% chance of migraine or headache when levels of progesterone were found high in the urine.

According to Andrew Hershey, MD, Ph.D., endowed chair and director of neurology at Cincinnati Children's Hospital Medical Center, "The shifting contribution of female hormones to migraine occurrence from pre-pubertal girls through puberty into adulthood suggests a very dynamic process." As the brain develops, it could react differently to hormones than a non-maturated brain."

Hershey explained that the girls might enter puberty between age 8-10 years old. However, their first period may not start before the age 12 or later. The young girls may experience certain cyclic hormonal fluctuations and irregular menstrual periods as they progress through this pubertal growth.

According to Hershey, a monthly headache pattern can begin during these initial stages. The menstrual periods become more regular as do hormone fluctuations and by age 17, most girls are showing adult hormone patterns. "But just having changes in hormones or regular menstrual periods isn't sufficient to estimate the differences in headache intensity and onset exhibited by adolescent girls compared to older teens."

Martin stated that the research team was able to estimate cyclic fluctuations of hormones and that they were not found to be imminent of headache onset. The urine progesterone levels were preventive in the older teens, and that was more of an adult response; it is what is suspected to see in older women."The results of the present study suggest that female hormones play a crucial role in activating headaches in adolescent girls and that their response to hormones seems to vary at the time of puberty.