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Researchers Urge for New Menstrual Migraine Diagnostic Criteria
Menstrual migraine (MM) was found to have different clinical characteristics than non-menstrual migraine (non-MM), indicating a need to revisit diagnostic criteria, according to a recent case-control study published in JAMA Network Open.
“Our data showed that women with MM had a higher frequency of migraine-accompanying symptoms, more frequent and severe migraine attacks, lower frequency of non-migraine headache, and better outcomes of treatment with triptans than women with non-MM,” said Mona Ameri Chalmer, MD, PhD, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark.
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The study was conducted among patients with migraine in Denmark. Participants completed a questionnaire, and the data was analyzed to compare the clinical characteristics of women with MM and women with non-menstrual migraine (non-MM). The International Classification of Headache Disorders, Third Edition (ICHD-3) diagnostic criteria was used to diagnose MM.
The study included 12,618 individuals with migraine, of which 16.6% (1532) had MM and 45.9% (4216) had non-MM. The mean age of women with MM was 38.7 years and 37.0 years for women with non-MM. Among the women with MM, 26.8% met the criteria for pure MM, 67.7% met the criteria for menstrually related migraine according to ICHD-3, and 9.9% met the proposed diagnostic criteria for rare pure MM.
Researchers found that MM was associated with a higher frequency and severity of migraine attacks, a higher prevalence of migraine-accompanying symptoms, and a lower frequency of non-migraine headaches compared to non-MM. Women with MM also showed a greater response to treatment with triptans, better improvement of migraine attacks during late pregnancy, and faster reappearance of migraine attacks postpartum. Hormonal contraceptive-related MM was associated with a higher prevalence of migraine without aura compared to spontaneous menstruation.
Researchers offered several proposed changes to the current diagnostic criteria for MM. Firstly, the authors suggest including women with rare pure MM attacks in the diagnostic criteria for pure MM. Secondly, they note that a large portion of women with chronic migraine (CM) or high-frequency episodic migraine (HFEM) meet the current MM criteria by chance. To account for this, CM and HFEM authors suggest that these be excluded from the new criteria. Thirdly, it is mentioned that the current criteria do not specify that MM attacks must start within a specific time frame relative to menstruation, whereas previous studies considered attacks occurring between days -2 to +3 of menstruation. Study authors recommend that this requirement be clarified. Lastly, the authors suggest allowing for more than 1 migraine attack during the menstrual period.
Researchers indicated several limitations that could have affected study results. The cohort of blood donors used in the study may not accurately represent the broader population, as it had fewer participants with severe comorbidities and a lower frequency of migraine days compared to the general population. Additionally, the use of self-reported data may have led to reporting bias. Information on the recurrence and timing of migraine attacks was also lacking, which should be explored in future research.
