Moderating Influence of Ovarian Hormones on Physiological Arousal and Headache

描述（由申请人提供）：给定患者的头痛症状可能每天变化很大，从偏头痛患者无症状的几天到他或她功能残疾并伴有严重头痛的几天。增加对诱发偏头痛的因素（“偏头痛诱因”）的了解将提高准确预测偏头痛发作的能力。这些知识将非常有利于规划药理学和行为管理策略，其中许多是在发作开始之前或在新的发作早期最佳应用。我们目前对偏头痛诱发因素的理解几乎完全基于单一诱发因素，采用横断面、基于人群的检查进行研究。多种沉淀剂对偏头痛发病的影响，或激素在调节任何单一沉淀剂影响中的作用尚不清楚。拟议的研究是一项观察性研究，利用卵巢激素的自然变异性来检查生理唤醒（例如，心率、呼吸频率、感知压力）、卵巢激素和一组对激素影响敏感的女性（即，她们患有与月经有关的偏头痛）偏头痛活动之间的关系。提出的研究背后的具体假设是，偏头痛活动可以通过心理生理唤醒独立预测，并且这种关系受到激素影响的调节。这项研究的数据将用于建立一个理论模型，该模型将大大提高我们对这一动态过程相互作用的理解。具体的目的是：目的1：检查几种心理生理唤醒和头痛活动之间的关系。目的2：探讨卵巢激素水平与头痛活动的关系。目的3：在卵巢激素对压力和偏头痛关系的潜在调节作用的背景下，研究生理唤醒对压力和偏头痛关系的中介作用。公共卫生相关性：根据最近的一项研究，90%的偏头痛患者报告头痛的功能损害，53%表现出严重的损害，需要卧床休息。在美国，偏头痛每年导致1.12亿个卧床不起的日子，偏头痛给美国劳动力造成的损失估计为每年130亿美元，其中包括错过工作日和生产力损失。本研究的目的是通过增加对头痛诱发因子的了解，使偏头痛发作更容易预测，从而通过在偏头痛发作期间进行早期干预来减轻偏头痛的负担。

DESCRIPTION (provided by applicant): Headache symptoms for a given patient may vary widely from one day to the next, ranging from days when the migraine sufferer is asymptomatic to days when he or she is functionally disabled with severe headache. Increased knowledge of the factors that precipitate migraine ("migraine triggers") will lead to an enhanced ability to accurately predict migraine attacks. This knowledge will be very beneficial for planning pharmacological and behavioral management strategies, many of which are optimally applied either before an attack begins or early in a new attack. Our current understanding of migraine precipitants is almost entirely based on single precipitants studied using cross-sectional, population-based examinations. The effect that multiple precipitants may have on initiating migraine, or the role of hormones in moderating the influence of any single precipitant is unclear. The proposed research is an observational study that utilizes the natural variability of ovarian hormones to examine the relationship between physiological arousal (e.g., heart rate, breath rate, perceived stress), ovarian hormones, and migraine activity in a group of women who are sensitive to hormonal influences (i.e., they have menstrually related migraine). The specific hypothesis behind the proposed research is that migraine activity can be independently predicted by psychophysiological arousal and that this relationship is moderated by hormonal influences. The data from the study will be used to inform a theoretical model that will greatly enhance our understanding of the interplay of this dynamic process. The specific aims are: Aim 1: To examine the relationships between several measures of psychophysiological arousal and headache activity. Aim 2: To examine the relationship between ovarian hormone levels and headache activity. Aim 3: To examine the mediating role of physiological arousal on the relationship between stress and migraine in the context of a potential moderating role of ovarian hormones on these relationships. PUBLIC HEALTH RELEVANCE: According to a recent study, 90% of migraineurs reported functional impairment with their headaches and 53% exhibited severe impairment requiring bed rest. In the United States, migraine results in 112 million bedridden days each year with the cost of migraine to the total American workforce estimated at $13 billion a year in missed workdays and lost productivity. The goal of the present research is to make migraine attacks more predictable by increasing knowledge of headache precipitants thus decreasing the burden of migraine by allowing for earlier intervention during a migraine attack.