The microgenderome in migraine: integrating sex hormones, microbial composition, and metabolic profiles into a sex-related framework
Abstract
Background: Migraine is a debilitating neurological disorder with marked sex differences, as women experience a prevalence two to three times higher than men. Although the gut-brain axis has been implicated in migraine biology, the intersection of sex hormones, microbial signaling, and microbial metabolites remains underexplored. This review evaluates migraine-specific and mechanistically relevant evidence on sex-related microbial and metabolic profiles to examine their potential relevance to sex-related characteristics of migraine.
Methods: This narrative review was informed by a structured literature search of PubMed through May 2026, identifying 22 relevant studies, including clinical studies, interventional studies, animal models, and mechanistic investigations. Given heterogeneity in study design, sequencing methods, sampling strategies, clinical populations, and outcome measures, evidence was synthesized narratively to develop a hypothesis-generating framework for interactions among sex hormones, microbiota, microbial metabolites, and migraine.
Results: Current evidence suggests that gut microbial diversity and composition may be altered in migraine, but sex-stratified migraine-specific data remain limited. Female migraine cohorts have shown reduced abundances of taxa such as Clostridia and Ruminococcus, alongside enrichment of pro-inflammatory genera including Desulfovibrio and Gemmiger, with reported associations with inflammatory markers such as interleukin-6 and…
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