Headache Medicine and Women's Health Series: Overview of Menstrual Migraine

Dr. Tesha Monteith discusses the different forms of menstrual migraines. 

Show transcript: 

Dr. Tesha Monteith:

Hi, this is Tesha Monteith with the Neurology Minute. Welcome to our series on headache medicine and women's health. I want to start off this series with a discussion on menstrual migraine. Menstrual migraine is considered more frequent, more severe, and is associated with most migraine-associated symptoms with the exception of aura. The pathophysiology is linked to the effects of estrogen withdrawal and the impacts on the trigeminal vascular system. Do check out a recent paper by Pan and colleagues published just in neurology in November showing a robust hypothalamic activation prior to the headache phase in patients with menstrual migraine compared to controls.

Now, there are two forms of menstrual migraine recognized in the International Classification of Headache Disorders III. First is menstrually related migraine which consists of attacks that occurred during the perimenstrual window. That's day one of menses plus or minus two days and at least two of three menstrual cycles and during additional times outside of the window. Perimenstrual migraine attacks occur exclusively during the perimenstrual window and is much less common than menstrually related migraine.

A key point is that there's a predictable timing with each cycle, yet the condition is still very much underdiagnosed. Advise your patients to use an e-diary to improve the diagnosis and hopefully reduce disability. This is Tesha Monteith. Thank you for listening to the Neurology Minute.