Women with migraine

Women with migraine have a higher frequency of excessive and/or prolonged menstrual bleeding and endometriosis, according to a study published recently in Headache, the journal of the American Headache Society. While as many as 60% of women experience migraine in conjunction with their menstrual periods, there is little information regarding the relationship between migraine and menstrual disorders.(1,2). A study published in 2004 found an increased prevalence of migraine in women with endometriosis (a condition in which the endometrial tissue is outside of the uterus) (3), but the reason for this association is unknown. Menstrual problems are common, and unusually heavy bleeding over several cycles in a row occurs in about 30% of women.4 Endometriosis affects 0.5% to 5% of fertile women and 25% to 40% of infertile women.(5-7)

To understand more about the association between menstrual disorders and migraine, Dr. Gretchen Tietjen of the Medical College of Ohio in Toledo, and colleagues, enrolled 50 female migraineurs (diagnosed according to the International Headache Society criteria) of childbearing age and 52 age-matched women. They were asked to complete a questionnaire regarding migraine and migraine-related disability, menstrual history, other bleeding history, vascular event history, and vascular risk factors.

The frequency of smoking, oral contraceptive use, and hormone replacement therapy was similar between the two groups of women. Twenty-three of the 50 migraineurs reported that migraine was associated with their menstrual period, and 36% suffered from chronic headache (15 or more days/month).

More migraineurs reported unusually heavy periods (63% vs. 37%), and endometriosis was more commonly diagnosed in migraineurs (30% vs. 4%). More migraineurs (24% vs. 14%) had undergone a hysterectomy, and endometriosis was identified as the reason in over half of the cases. Interference in life activities and mood from menstrual periods was three times more likely to be reported in migraineurs compared to controls.

A greater prevalence of hypertension (25% vs. 10%) and Raynaud’s disease (10% vs. 2%) and the trend to report transient ischemic attacks/stroke (10% vs. 2%) in the migraine group suggest an altered vascular response,8 but the researchers say the study is too small to make any definitive conclusions.

They say the findings support further research to study the factors influencing endometriosis and menstrual blood flow, such as hormonal influences and blood clotting disorders.


1. Kelman L. Women’s issues of migraine in tertiary care. Headache 2004;44:2-7.
2. Epstein MT, et al. Migraine and reproductive hormones throughout the menstrual cycle. Lancet 1975;1:543-548.
3. Ferrero S, et al. Increased frequency of migraine among women with endometriosis. Hum Reprod 2004;19:2927-2932.
4. Oehler MK, Rees MC. Menorrhagia: an update. Acta Obstet Gynecol Scand 2003;82:405-422.
5. Houston DE, et al. Incidence of pelvic endometriosis in Rochester, Minnesota, 1970-79. Am J Epidemiol 1987;125:959-969.
6. Strathy JH, et al. Endometriosis and infertility: a laparoscopic study of endometriosis among fertile and infertile women. Fertil Steril 1982;38:667-672.
7. Haupt BJ. Utilization of short-stay hospitals: annual summary for the United States, 1980. Vital Health Stat 1982;13:1-60.
8. Planchon B, et al. A quantitative test for measuring reactivity to cold by the digital plethysmograph technique: application to 66 control subjects and 65 patients with Raynaud’s phenomenon. Angiology 1986;37:433-439.


Tietjen GE, et al. Migraine is associated with menorrhagia and endometriosis. Headache 2006; doi:10.1111/j.1526-4610.2006.00290.x

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