Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study

Iris E. Verhagen; Britt Wh van der Arend; Daphne S. van Casteren; Niels Js Thiermann; Evelien Tange; Antoinette MaassenVanDenBrink; Gisela M. Terwindt

doi:10.1177/03331024231164322

Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study

Iris E. Verhagen, Britt Wh van der Arend, Daphne S. van Casteren, Niels Js Thiermann, Evelien Tange, Antoinette MaassenVanDenBrink, Gisela M. Terwindt^*

^*Corresponding author for this work

Internal Medicine

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Abstract

BACKGROUND: Previous studies showed that the perimenstrual window is associated with an increased susceptibility to migraine attacks without aura, but had conflicting results regarding attacks with aura. METHODS: We performed a longitudinal E-diary study among 526 premenopausal women with migraine. Differences in occurrence of perimenstrual migraine attacks between women with migraine with aura and without aura were assessed using a mixed effects logistic regression model. Additionally, participants completed a questionnaire about the influence of hormonal milestones on migraine frequency. RESULTS: Prevalence of menstrual migraine did not differ between women with migraine without aura and migraine with aura (59% versus 53%, p = 0.176). The increased risk of migraine attacks without aura during the perimenstrual window was similar for women with migraine without aura (OR[95%CI]:1.53 [1.44-1.62]) and those with migraine with aura (1.53 [1.44-1.62]). The perimenstrual window was not associated with increased risk of migraine aura attacks (1.08 [0.93-1.26], p = 0.314). Women with migraine with aura more often reported increased migraine frequency during pregnancy and breastfeeding compared to women with migraine without aura, but not during hormonal contraception use. CONCLUSION: Sex hormone levels seem to differently affect the trigeminovascular system (migraine headache) and the susceptibility to cortical spreading depolarization (aura). Exclusively migraine attacks without aura should be interpreted as perimenstrual attacks.

Original language	English
Article number	3331024231164322
Journal	Cephalalgia : an international journal of headache
Volume	43
Issue number	6
DOIs	https://doi.org/10.1177/03331024231164322
Publication status	Published - Jun 2023

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Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by ZonMw (849200007) and the Dutch Brain Foundation (HA2017.01.05).

Publisher Copyright:
© The Author(s) 2023.

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Verhagen, I. E., van der Arend, B. W., van Casteren, D. S., Thiermann, N. J., Tange, E., MaassenVanDenBrink, A., & Terwindt, G. M. (2023). Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study. Cephalalgia : an international journal of headache, 43(6), Article 3331024231164322. https://doi.org/10.1177/03331024231164322

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title = "Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study",

abstract = "BACKGROUND: Previous studies showed that the perimenstrual window is associated with an increased susceptibility to migraine attacks without aura, but had conflicting results regarding attacks with aura. METHODS: We performed a longitudinal E-diary study among 526 premenopausal women with migraine. Differences in occurrence of perimenstrual migraine attacks between women with migraine with aura and without aura were assessed using a mixed effects logistic regression model. Additionally, participants completed a questionnaire about the influence of hormonal milestones on migraine frequency. RESULTS: Prevalence of menstrual migraine did not differ between women with migraine without aura and migraine with aura (59% versus 53%, p = 0.176). The increased risk of migraine attacks without aura during the perimenstrual window was similar for women with migraine without aura (OR[95%CI]:1.53 [1.44-1.62]) and those with migraine with aura (1.53 [1.44-1.62]). The perimenstrual window was not associated with increased risk of migraine aura attacks (1.08 [0.93-1.26], p = 0.314). Women with migraine with aura more often reported increased migraine frequency during pregnancy and breastfeeding compared to women with migraine without aura, but not during hormonal contraception use. CONCLUSION: Sex hormone levels seem to differently affect the trigeminovascular system (migraine headache) and the susceptibility to cortical spreading depolarization (aura). Exclusively migraine attacks without aura should be interpreted as perimenstrual attacks.",

author = "Verhagen, {Iris E.} and {van der Arend}, {Britt Wh} and {van Casteren}, {Daphne S.} and Thiermann, {Niels Js} and Evelien Tange and Antoinette MaassenVanDenBrink and Terwindt, {Gisela M.}",

note = "Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by ZonMw (849200007) and the Dutch Brain Foundation (HA2017.01.05). Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2023",

month = jun,

doi = "10.1177/03331024231164322",

language = "English",

volume = "43",

journal = "Cephalalgia : an international journal of headache",

issn = "0333-1024",

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Verhagen, IE, van der Arend, BW, van Casteren, DS, Thiermann, NJ, Tange, E, MaassenVanDenBrink, A & Terwindt, GM 2023, 'Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study', Cephalalgia : an international journal of headache, vol. 43, no. 6, 3331024231164322. https://doi.org/10.1177/03331024231164322

Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study. / Verhagen, Iris E.; van der Arend, Britt Wh; van Casteren, Daphne S. et al.
In: Cephalalgia : an international journal of headache, Vol. 43, No. 6, 3331024231164322, 06.2023.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones

T2 - A prospective cohort study

AU - Verhagen, Iris E.

AU - van der Arend, Britt Wh

AU - van Casteren, Daphne S.

AU - Thiermann, Niels Js

AU - Tange, Evelien

AU - MaassenVanDenBrink, Antoinette

AU - Terwindt, Gisela M.

N1 - Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by ZonMw (849200007) and the Dutch Brain Foundation (HA2017.01.05). Publisher Copyright: © The Author(s) 2023.

PY - 2023/6

Y1 - 2023/6

N2 - BACKGROUND: Previous studies showed that the perimenstrual window is associated with an increased susceptibility to migraine attacks without aura, but had conflicting results regarding attacks with aura. METHODS: We performed a longitudinal E-diary study among 526 premenopausal women with migraine. Differences in occurrence of perimenstrual migraine attacks between women with migraine with aura and without aura were assessed using a mixed effects logistic regression model. Additionally, participants completed a questionnaire about the influence of hormonal milestones on migraine frequency. RESULTS: Prevalence of menstrual migraine did not differ between women with migraine without aura and migraine with aura (59% versus 53%, p = 0.176). The increased risk of migraine attacks without aura during the perimenstrual window was similar for women with migraine without aura (OR[95%CI]:1.53 [1.44-1.62]) and those with migraine with aura (1.53 [1.44-1.62]). The perimenstrual window was not associated with increased risk of migraine aura attacks (1.08 [0.93-1.26], p = 0.314). Women with migraine with aura more often reported increased migraine frequency during pregnancy and breastfeeding compared to women with migraine without aura, but not during hormonal contraception use. CONCLUSION: Sex hormone levels seem to differently affect the trigeminovascular system (migraine headache) and the susceptibility to cortical spreading depolarization (aura). Exclusively migraine attacks without aura should be interpreted as perimenstrual attacks.

AB - BACKGROUND: Previous studies showed that the perimenstrual window is associated with an increased susceptibility to migraine attacks without aura, but had conflicting results regarding attacks with aura. METHODS: We performed a longitudinal E-diary study among 526 premenopausal women with migraine. Differences in occurrence of perimenstrual migraine attacks between women with migraine with aura and without aura were assessed using a mixed effects logistic regression model. Additionally, participants completed a questionnaire about the influence of hormonal milestones on migraine frequency. RESULTS: Prevalence of menstrual migraine did not differ between women with migraine without aura and migraine with aura (59% versus 53%, p = 0.176). The increased risk of migraine attacks without aura during the perimenstrual window was similar for women with migraine without aura (OR[95%CI]:1.53 [1.44-1.62]) and those with migraine with aura (1.53 [1.44-1.62]). The perimenstrual window was not associated with increased risk of migraine aura attacks (1.08 [0.93-1.26], p = 0.314). Women with migraine with aura more often reported increased migraine frequency during pregnancy and breastfeeding compared to women with migraine without aura, but not during hormonal contraception use. CONCLUSION: Sex hormone levels seem to differently affect the trigeminovascular system (migraine headache) and the susceptibility to cortical spreading depolarization (aura). Exclusively migraine attacks without aura should be interpreted as perimenstrual attacks.

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DO - 10.1177/03331024231164322

M3 - Article

C2 - 37259230

AN - SCOPUS:85160682440

SN - 0333-1024

VL - 43

JO - Cephalalgia : an international journal of headache

JF - Cephalalgia : an international journal of headache

IS - 6

M1 - 3331024231164322

ER -

Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study

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