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Peer-reviewedCC BY-NC-ND 4.0BMC Neurology

Hormonal, metabolic, and stress-related clinical differences between episodic and chronic migraine: insights for diagnostic and therapeutic approaches

  • Rabia Gokcen Gozubatik-Celik1
  • Ezgi Uludüz2
  • Sevim Eyüboğlu3
  • Mustafa İskender4
  • Mehmet Ali Sungur5
  • Aynur Özge6
  • Derya Uludüz7
7 affiliations
  1. 1Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Mental Health and Neurological Disorders, Department of Neurology, University of Health Sciences, Istanbul, Türkiye
  2. 2Koc University Medical Faculty, Grade III student, Istanbul, Türkiye
  3. 3Brain360 Integrative Brain Health Center, Istanbul, 34337 Türkiye
  4. 4Romatem Physical Therapy and Rehabilitation Hospital, Kocaeli, Kocaeli 41000 Turkey
  5. 5Department of Biostatistics and Medical Informatics, Duzce University Faculty of Medicine, Düzce, Türkiye
  6. 6Department of Neurology, Mersin University School of Medicine, Mersin, 33110 Turkey
  7. 7Medical Faculty, Istanbul Atlas University, Istanbul, Turkey
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Abstract

Background: Migraine, a common neurological disorder, is categorized into episodic (EM) and chronic (CM) forms. Understanding their hormonal and metabolic differences can enhance insights into migraine pathophysiology and guide clinical approaches.

Objective: To explore hormonal and metabolic imbalances in EM and CM patients and identify key factors contributing to migraine chronicity.

Methods: This retrospective, cross-sectional study included 500 patients with migraine (318 EM and 182 CM). Data were retrospectively extracted from pre-existing clinical records, structured intake forms, physician examination notes, questionnaire-based assessments, and available laboratory results to evaluate demographic, clinical, metabolic, stress-related, mental health-related, and comorbidity variables.

Results: CM patients were older (46.28 vs. 43.13 years, p = 0.002) and had more frequent severe attacks (15 vs. 8/month) and mild attacks (12 vs. 6/month) (p < 0.001). CM patients exhibited higher rates of anaemia (34.9% vs. 25.7%, p = 0.035), asthma (12.8% vs. 7.3%, p = 0.046), and sleep apnea (4.7% vs. 1.3%, p = 0.034). Fibromyalgia-related symptoms were common in both groups (82.1% in CM vs. 78.2% in EM), while the number of fibromyalgia tender points was higher in CM than in EM patients (median 8 vs. 6). Ferritin levels were lower in CM but not significantly so (p = 0.139). Suicidal thoughts and feelings of helplessness were more common in CM (p = 0.016, p = 0.002). CM patients used Botox more often but with lower efficacy and engaged in more cognitive behavioural therapy (p = 0.002).

Conclusion: CM was associated with more severe symptoms, higher comorbidity burden, more widespread pain features, and distinct metabolic and stress-related profiles compared with EM. These findings support the early recognition of clinical and comorbid factors associated with the chronic migraine phenotype.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12883-026-05169-w.

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Cite

BibTeXRIS
BibTeX
@article{gozubatikcelik2026hormonal,
  title = {{Hormonal, metabolic, and stress-related clinical differences between episodic and chronic migraine: insights for diagnostic and therapeutic approaches}},
  author = {Rabia Gokcen Gozubatik-Celik and Ezgi Uludüz and Sevim Eyüboğlu and Mustafa İskender and Mehmet Ali Sungur and Aynur Özge and Derya Uludüz},
  journal = {BMC Neurology},
  year = {2026},
  month = jul,
  doi = {10.1186/s12883-026-05169-w},
  url = {https://doi.org/10.1186/s12883-026-05169-w},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Hormonal, metabolic, and stress-related clinical differences between episodic and chronic migraine: insights for diagnostic and therapeutic approaches
AU  - Rabia Gokcen Gozubatik-Celik
AU  - Ezgi Uludüz
AU  - Sevim Eyüboğlu
AU  - Mustafa İskender
AU  - Mehmet Ali Sungur
AU  - Aynur Özge
AU  - Derya Uludüz
PY  - 2026
DA  - 2026/07/21
JO  - BMC Neurology
DO  - 10.1186/s12883-026-05169-w
UR  - https://doi.org/10.1186/s12883-026-05169-w
AB  - Background: Migraine, a common neurological disorder, is categorized into episodic (EM) and chronic (CM) forms. Understanding their hormonal and metabolic differences can enhance insights into migraine pathophysiology and guide clinical approaches.  Objective: To explore hormonal and metabolic imbalances in EM and CM patients and identify key factors contributing to migraine chronicity.  Methods: This retrospective, cross-sectional study included 500 patients with migraine (318 EM and 182 CM). Data were retrospectively extracted from pre-existing clinical records, structured intake forms, physician examination notes, questionnaire-based assessments, and available laboratory results to evaluate demographic, clinical, metabolic, stress-related, mental health-related, and comorbidity variables.  Results: CM patients were older (46.28 vs. 43.13 years, p = 0.002) and had more frequent severe attacks (15 vs. 8/month) and mild attacks (12 vs. 6/month) (p < 0.001). CM patients exhibited higher rates of anaemia (34.9% vs. 25.7%, p = 0.035), asthma (12.8% vs. 7.3%, p = 0.046), and sleep apnea (4.7% vs. 1.3%, p = 0.034). Fibromyalgia-related symptoms were common in both groups (82.1% in CM vs. 78.2% in EM), while the number of fibromyalgia tender points was higher in CM than in EM patients (median 8 vs. 6). Ferritin levels were lower in CM but not significantly so (p = 0.139). Suicidal thoughts and feelings of helplessness were more common in CM (p = 0.016, p = 0.002). CM patients used Botox more often but with lower efficacy and engaged in more cognitive behavioural therapy (p = 0.002).  Conclusion: CM was associated with more severe symptoms, higher comorbidity burden, more widespread pain features, and distinct metabolic and stress-related profiles compared with EM. These findings support the early recognition of clinical and comorbid factors associated with the chronic migraine phenotype.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12883-026-05169-w.
SN  - 1471-2377
ER  -