Abstract
BackgroundTo compare symptoms of clinical androgen deficiency between men with migraine, men with cluster headache and non-headache male controls.MethodsWe performed a cross-sectional study using two validated questionnaires to assess symptoms of androgen deficiency in males with migraine, cluster headache, and non-headache controls. Primary outcome was the mean difference in androgen deficiency scores. Generalized linear models were used adjusting for age, BMI, smoking and lifetime depression. As secondary outcome we assessed the percentage of patients reporting to score below average on four sexual symptoms (beard growth, morning erections, libido and sexual potency) as these items were previously shown to more specifically differentiate androgen deficiency symptoms from (comorbid) anxiety and depression.ResultsThe questionnaires were completed by n = 534/853 (63%) men with migraine, n = 437/694 (63%) men with cluster headache and n = 152/209 (73%) controls. Responders were older compared to non-responders and less likely to suffer from lifetime depression.Patients reported more severe symptoms of clinical androgen deficiency compared with controls, with higher AMS scores (Aging Males Symptoms; mean difference ± SE: migraine 5.44 ± 0.90, p < 0.001; cluster headache 5.62 ± 0.99, p < 0.001) and lower qADAM scores (quantitative Androgen Deficiency in the Aging Male; migraine: − 3.16 ± 0.50, p < 0.001; cluster headache: − 5.25 ± 0.56, p < 0.001). Additionally, both patient groups more often reported to suffer from any of the specific sexual symptoms compared to controls (18.4% migraine, 20.6% cluster headache, 7.2% controls, p = 0.001).ConclusionMen with migraine and cluster headache more often suffer from symptoms consistent with clinical androgen deficiency than males without a primary headache disorder.
Highlights
Migraine and cluster headache are primary headache disorders that share certain pathophysiological characteristics, but have a very different epidemiology and phenotype
Participants were selected from the Leiden University Migraine Neuro Analysis (LUMINA) and the Leiden University Cluster headache neuro Analysis (LUCA) cohort [9, 10]
We sent an invitation to participate in this specific study to n = 853 migraine patients, n = 694 cluster headache patients, and n = 209 controls without headache
Summary
Migraine and cluster headache are primary headache disorders that share certain pathophysiological characteristics, but have a very different epidemiology and phenotype. With migraine being a predominantly female disease, a limited number of studies has investigated sex hormones in men, but one small scale study showed a decreased testosterone/estradiol ratio in males with migraine [5]. Recent studies show that cluster headache occurs in women more often than previously assumed with a male to female ratio of 2:1 [6]. Onset of cluster headache before puberty is rare and cluster headache patients have been characterized as over-masculinized [7]. These clinical observations may suggest a role for androgens in cluster headache pathophysiology, but several small studies evaluating androgens, and testosterone in particular, have led to conflicting results. To compare symptoms of clinical androgen deficiency between men with migraine, men with cluster headache and non-headache male controls
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