Pelvic congestion syndrome, migraine and dilating venous disease: Interesting but not surprising.

Dear Editor, We have recently read the exciting article published by Smith et al. with great pleasure and enthusiasm. They have admirably assessed the prevalence of coexisting symptoms and self-reported syndrome diagnoses among women with pelvic congestion syndrome (PCS). The most commonly encountered symptoms are severe fatigue (72%), dizziness (63%), irritable bowel syndrome symptoms (61%), migraines (49%), polyuria or dysuria (41%). This survey conducted by Smith et al. is an example of multi-disciplinary approach to PCS by means of self-reported co-existing symptoms or syndromes. Notably PCS, also known as pelvic varicocele, comprises the pathologic dilatation of broad ligament, ovarian plexus veins and incompetent ovarian veins and has been also classified as a member of dilating venous diseases (DVD). It has been proposed that lower extremity peripheral varicose veins, varicocele, hemorrhoids and PCS per se are not only the localized disease of related venous vascular territory but also a localized manifestation of systemic venous or vascular wall abnormality. We would like to pay particular attention on the relatively high prevalence of migraine. Given the fact that pelvic congestion syndrome or pelvic varicosities is a member and localized manifestation of DVDs, it is interesting but not surprising to see high prevalence of migraine in patients with PCS. Indeed, it has recently been documented that migraineours have a higher degree of venous leg complaints and discomfort assessed by the VEINES-Sym questionnaire compared to non-migraineours. Abnormal venous wall structure, decreased venous elasticity, increased venous pressure and eventual venous congestion of brain have also been involved in the pathogenesis of migraine. Therefore, venous circulation abnormality is likely to be a contributing factor on the pathophysiology of migraines. In this regard, coincidental high prevalence of migraine in patients with PCS deserves to be investigated to elucidate the pathophysiological association between the PCS and migraine in terms of cerebral venous vascular pathology and DVD.