[Effect of hormones on headaches in women and the associated endometrial patterns]. / L'influenza degli ormoni sulle cefalee nella donna e gli aspetti endometriali associati

Headaches appear to be a reaction to changes in either exogenous levels. We are now investigating serum immunoglobulins in women with menstrual migraine and have found that in 22 women, 6 have low immunoglobulin A levels, all below the normal range, and 5 have high immunoglobulin M levels, above the normal range. The hereditary aspect of migraine may depend on inheriting a particular immune pattern which might cause a special sensitivity to hormone effects on blood vessels. This might account for the suppression of menstrual migraine by cortisone or large doses of progesterone. Deficiency of progesterone is unlikely to be responsible for the premenstrual syndrome as the week following menstruation is usually the time which is most often free from symptoms and at this part of the cycle there are very low levels of progesterone. The most reactive women are also the most sensitive to the side effects of drugs or hormones given to treat migraine, which makes the treatment of migraine difficult.

Food allergies and migraine.

60 migraine patients completed elimination diets after a 5-day period of withdrawal from their normal diet. 52 (87%) of these patients had been using oral contraceptive steroids, tobacco, and/or ergotamine for an average of 3 years, 22 years, and 7.4 years respectively. The commonest foods causing reactions were wheat (78%), orange (65%), eggs (45%), tea and coffee (40% each), chocolate and milk (37%) each), beef (35%), and corn, cane sugar, and yeast (33% each). When an average of ten common foods were avoided there was a dramatic fall in the number of headaches per month, 85% of patients becoming headache-free. The 25% of patients with hypertension became normotensive. Chemicals in the home environment can make this testing difficult for outpatients. Both immunological and non-immunological mechanisms may play a part in the pathogenesis of migraine caused by food intolerance.

Relation between headaches from oral contraceptives and development of endometrial arterioles.

The incidence of headaches during the first year on oral cotraceptives corrleates closely with the incidence of well-developed arterioles in endometrial biopsy specimens. This relationship appears to depend on the ratio between progestogenic and oestrogenic components of the pill as well as the particular steroids. Therefore endometrial biopsies are useful for assessing the vascular response to an oral contraceptive and also provide a short cut to clinical evaluation of new formulations.

Venous effects of oral contraceptives.

In a five-year analysis of an oral contraceptive trial by the Council for the Investigation of Fertility Control venous effects were the third most troublesome group of side-effects with both combined and sequential therapy. Vein complaints, leg cramps, and thrombophlebitis were significantly more frequent with the combined preparations that contained a relatively low dose of progestogen and a high dose of oestrogen than with the other groups tested. No cases of thrombophlebitis occurred in women taking the strongly oestrogenic sequential groups.Histological examination of uterine curettings showed that most progestogenic combined preparations were associated with a high incidence of dilated endometrial sinusoids, while the oestrogenic sequential regimens and low-dose progestogen-only regimens had a low incidence. The incidence of stromal condensation round the sinusoids correlated with the incidence of leg cramps, and these effects appeared to be specific for each preparation tested.

Oral contraceptives and the uterine vessels.

PIP: This letter is in reply to a previous article of April 30 asking if oral contraceptives cause disease of the uterine arteries. The writer has found that changes in the small vessels of the endometrium are an early effect of taking oral contraceptives. Proliferation of endometrial arterioles has been related to headache and migraine incidence. Distended sinusoids have accompanied tiredness and dilated leg veins. Stromal condensation around sinusoids has been found with leg cramps. These changes have preceded thrombosis. It is thought that oral contraceptives cause generalized vascular overactivity. Symptoms are usually rapidly reversible on discontinuing the therapy. At an acute migraine clinic, oral contraceptives and smoking have been important contributing factors in patients requiring emergency treatment. Oral contraceptives are thought to be a more potent cause of bascular disease than smoking.^ieng

Side effects of the pill.

PIP: In response to a letter by Drs. D.M. and S.M. Hall calling loss of libido with oral contraceptive use only psychological, the author states it would seem that drugs which can produce an atrophic endometrium and a dry vagina might also cause loss or decrease of libido. The progestogenic low-estrogen compounds produce endometrial glands which have a high level of monoamine oxidase, particularly in the premenstrual phase. The author has found a correlation of depression and loss of libido with the endometrial monoamine oxidase activity. Estrogenic sequential regimens had a low incidence of depression and low monoamide oxidase activity. The Halls' data, with a much greater number of women under age 30, implies that oral contraceptives are not well tolerated by older women. Women under age 20 seem to be slower to have depression changes. Unmarried women may be more reluctant to admit to side effects because of their need for an efficient contraceptive. In the author's follow-up of 341 women, 40% noted mood changes and headaches on discontinuing oral contraceptives. Of 31 women stopping low-estrogen compounds 70% noted depressive mood changes.^ieng

The R.C.G.P. oral contraception study.

PIP: The latest report from the Royal College of General Practitioners Oral Contraceptive Study supersedes their 1977 paper and handles the intermittent pill users differently. The report concentrates on deaths from circulatory disorders and their relation to oral contraceptive (OC) use and to age and smoking habits. The yearly drop-out rate is said to average 6.4% in the ever-users and 6.6% in the controls. This represents a 54% loss to follow-up. Were the drop-out rates the same for the women who were new OC users when enrolled into the study? The RCGP study gives a relative risk of 1.5 for deaths due to accidents and violence, the numbers of such deaths being 34 in the ever users and 17 in the controls. Vessey et al. found admission rates for self-poisoning (per 1000 woman years) to be 0.83 for OC users, 0.21 for diaphragm users, and 0.40 for women fitted with an IUD. This sample was aged 25-39, thus excluding younger women who are more likely to take overdoses. The mental effects of OC use are too important to be ignored. For cancer deaths the relative risk was 1.0. There were 19 deaths due to breast cancer in the ever-users and 10 in the controls.^ieng

Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases.

Significant variations in the incidence of depression and loss of libido were found with the various types of oral contraceptives. The highest incidence occurred with strongly progestogenic compounds (especially with those containing a small amount of oestrogen) which have high monoamine oxidase activity for most of the cycle. The lowest incidence was found with the strongly oestrogenic sequential regimens which have weak monoamine oxidase activity for most of the cycle.

The effect of ginseng on lifespan and stress responses in mice.

It has been suggested that ginseng can increase long-term resistance to stress and disease and therefore affect the lifespan. We set out to investigate this idea by testing whether the continuous administration of ginseng could affect the lifespan of mice and/or their behavioural responses to stress. 270 mice of strain LACa were divided into three groups: one group which was given ginseng from 8 weeks of age, a second group which was given ginseng from 52 weeks of age and an untreated control group. The mice were generally healthy. Their weights remained stable throughout their lifespan and were not altered by ginseng. Ginseng administration did not significantly alter the lifespan. However, ginseng did cause an exaggeration of the behavioural responses to mild stress. This effect was noticeable soon after ginseng administration and subsequently was maintained.

[The influence of hormones on headaches in women and the associated endometrial patterns (author's transl)]. / Der Einfluss von Hormonen auf den Kopfschmerz bei Frauen und die damit verbundenen Veränderungen am Endometrium

Headaches appear to be a reaction to changes in either exogenous or endogenous levels. We are now investigating serum immunoglobulins in women with menstrual migraine and have found that in 22 women, 6 have low immunoglobulin A levels, all below the normal range, and 5 have high immunoglobulin M levels, above the normal range. The hereditary aspect of migraine may depend on inheriting a particular immune pattern which might cause a special sensitivity to hormone effects on blood vessels. This might account for the suppression of menstrual migraine by cortisone or large doses of progesterone. Deficiency of progesterone is unlikely to be responsible for the premenstrual syndrome as the week following menstruation is usually the time which is most often free from symptoms and at this part of the cycle there are very low levels of progesterone. The most reactive women are also the most sensitive to the side effects of drugs or hormones given to treat migraine, which makes the treatment of migraine difficult.

Comparison of concentrations of some trace, bulk, and toxic metals in the hair of normal and dyslexic children.

Hair from dyslexic children, analyzed by flameless atomic absorption spectrometry, showed significantly higher concentrations of magnesium and copper than did hair from control subjects. The hair from dyslexic children also contained significantly higher concentrations of aluminum and cadmium than that from control children; the cadmium concentration exceeded the normal acceptable range. There were no significant differences in the case of lead, calcium, selenium, or mercury. Our results indicate that excessive cadmium burden could be implicated in this form of learning disorder.

Budd-Chiari syndrome: treatment with percutaneous transhepatic recanalization and dilation.

The authors describe a child with Budd-Chiari syndrome secondary to membranous obstruction of the hepatic veins and a web in the inferior vena cava. Transhepatic catheter venography demonstrated the occlusion, which was recanalized and dilated percutaneously via a transhepatic approach. Hepatomegaly and ascites decreased promptly and the prothrombin time became normal.