Evaluation of Perimenstrual Migraine Attacks Using “Headache Diary” Data

Abstract

Background

Menstrual migraine (MM), a hormone-related migraine type, is frequently underdiagnosed because current classification systems, especially the International Classification of Headache Disorders (ICHD)-3, are inadequate. Alternative diagnostic models for MM, which consider aura and attack timing, have recently been proposed to improve clinical spectrum capture. This research investigated the occurrence and clinical traits of MM in reproductive-aged women, contrasting the diagnostic effectiveness of the ICHD-3 and Chalmer et al.′s proposed criteria via prospective headache diary data.

Methods

This cross-sectional observational study included 138 menstruating women aged 18–50 diagnosed with migraine. Over a 6-month period, participants used diaries to record headache attacks, noting frequency, intensity, aura presence, and menstrual cycle phase. Migraine subtypes were classified using the ICHD-3 and Chalmer et al.′s criteria.

Results

Based on the ICHD-3 criteria, the study found that 2.2% of participants had pure menstrual migraine (PMM), 29.0% had menstrually related migraine (MRM), and 68.8% were classified as non-MRM. The revised criteria revealed a subtype redistribution, improving the identification of perimenstrual attacks. PMM correlated with significantly increased vomiting (70.0%) and recurrent attacks within the same cycle (90.0%). MRM groups showed significantly fewer visual auras (p = 0.001). The classification systems showed substantial agreement, as indicated by Cohen′s kappa (κ = 0.729, p < 0.001).

Conclusion

This research highlights the variable clinical presentation of MM and proposes that using the revised criteria could lead to better diagnoses and more specific treatment plans.