Menstrual migraine

This issue of Neurology contains two articles that focus on one aspect of the female migraine experience—that of attacks associated with the menstrual period.1,2⇓ For many women with migraine, the timing of attacks is not random but correlates closely with the decline of estrogen that precedes menstruation or occurs during the pill-free week of combination oral contraceptives. The perception of many doctors and patients is that these headaches are much more severe and disabling than other migraine attacks, but a large, population-based diary study did not confirm that view.3 Nonetheless, as the article by MacGregor and Hackshaw1 notes, population-based studies may not accurately characterize the experience of individuals. They used a “within-woman” analysis of headache diary data from 155 women with migraine attending a specialty headache clinic. The pooled relative risk that a migraine would occur during the premenstrual or postmenstrual interval was then compared with the risk of a migraine attack at all other times of the month. Using this method, migraine was 1.7 times as likely to occur during the 2 days …