Population-Based Characterization of Menstrual Migraine and Proposed Diagnostic Criteria

Mona Ameri Chalmer; Lisette J.A. Kogelman; Henrik Ullum; Erik Sørensen; Maria Didriksen; Susan Mikkelsen; Khoa Manh Dinh; Thorsten Brodersen; Kaspar R. Nielsen; Mie Topholm Bruun; Karina Banasik; Søren Brunak; Christian Erikstrup; Ole Birger Pedersen; Sisse Rye Ostrowski; Jes Olesen; Thomas Folkmann Hansen

doi:10.1001/jamanetworkopen.2023.13235

Population-Based Characterization of Menstrual Migraine and Proposed Diagnostic Criteria

Mona Ameri Chalmer, Lisette J.A. Kogelman, Henrik Ullum, Erik Sørensen, Maria Didriksen, Susan Mikkelsen, Khoa Manh Dinh, Thorsten Brodersen, Kaspar R. Nielsen, Mie Topholm Bruun, Karina Banasik, Søren Brunak, Christian Erikstrup, Ole Birger Pedersen, Sisse Rye Ostrowski, Jes Olesen, Thomas Folkmann Hansen

Department of Molecular Biology and Genetics - Bioinformatics Research Centre (BiRC), Rigshospitalet
Department of Clinical Medicine - Department of Clinical Immunology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

5 Citations (Scopus)

Abstract

Importance: There is a need for better recognition and more extensive research into menstrual migraine (MM) in the general population, and a revision of the diagnostic criteria for MM is warranted to move the field forward. Increased understanding of MM is crucial for improving clinical care, diagnosis, and therapy for MM. Objectives: To assess the clinical characteristics of MM, including severity and treatment response, and to propose new diagnostic criteria for pure MM and menstrually related migraine. Design, Setting, and Participants: This is a case-control study of Danish individuals with migraine. All individuals completed a 105-item validated diagnostic migraine questionnaire, sent via the Danish electronic mailing system (e-Boks) between May and August 2020, allowing diagnosis of pure MM and menstrually related migraine by the International Classification of Headache Disorders, Third Edition (ICHD-3). Data analysis was performed from September 2021 to November 2022. Exposure: Diagnosis of migraine. Main Outcomes and Measures: Clinical characteristics of women with MM and women with nonmenstrual migraine (non-MM) were compared using the ICHD-3 diagnostic criteria. A simulation of the risk of randomly misclassifying MM was based on number of migraine attacks during 3 menstrual cycles (3 × 28 days), and simulation analyses were performed using 100 000 permutations of random migraine attacks in migraine patients. Results: A total of 12 618 individuals, including 9184 women, with migraine participated in the study. Among the women with migraine, the prevalence of MM was 16.6% (1532 women), and the prevalence of non-MM was 45.9% (4216 women). The mean (SD) age was 38.7 (8.7) years for women with MM and 37.0 (9.2) years for women with non-MM. Of the 1532 women with MM, 410 (26.8%) fulfilled ICHD-3 diagnostic criteria for pure MM, 1037 (67.7%) fulfilled ICHD-3 diagnostic criteria for menstrually related migraine, and 152 (9.9%) fulfilled proposed diagnostic criteria for rare pure MM. MM was associated with a higher frequency of migraine-accompanying symptoms (odds ratio [OR], 1.98; 95% CI, 1.71-2.29), more frequent (OR, 7.21; 95% CI, 5.77-9.03) and more severe (OR, 1.17; 95% CI, 1.13-1.21) migraine attacks, lower frequency of nonmigraine headache (OR, 0.31; 95% CI, 0.18-0.49), an overall greater response to treatment with triptans (OR, 1.66; 95% CI, 1.24-2.24), better improvement of migraine attacks during late pregnancy (OR, 5.10; 95% CI, 2.17-14.00), and faster reappearance of migraine attacks post partum (OR, 3.19; 95% CI, 2.40-4.25). Hormonal contraceptive-related MM was associated with a higher prevalence of migraine without aura than migraine related to spontaneous menstruation (OR, 1.82; 95% CI, 1.62-2.06). Otherwise, no differences between hormonal and spontaneous MM were observed. The risk of random diagnostic misclassification of ICHD-3 menstrually related migraine in women with high frequency episodic migraine was 43%. This risk was reduced to 3% when applying the proposed criteria for menstrually related migraine. Conclusions and Relevance: In this case-control study, MM in the general population had clinical characteristics that were quantitively different from those of non-MM. Detailed descriptive data and suggested improved diagnostic criteria for pure MM and menstrually related migraine were provided.

Original language	English
Journal	JAMA network open
Volume	6
Issue	5
Pages (from-to)	e2313235
ISSN	2574-3805
DOIs	https://doi.org/10.1001/jamanetworkopen.2023.13235
Publication status	Published - 1 May 2023

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Chalmer, M. A., Kogelman, L. J. A., Ullum, H., Sørensen, E., Didriksen, M., Mikkelsen, S., Dinh, K. M., Brodersen, T., Nielsen, K. R., Bruun, M. T., Banasik, K., Brunak, S., Erikstrup, C., Pedersen, O. B., Ostrowski, S. R., Olesen, J., & Hansen, T. F. (2023). Population-Based Characterization of Menstrual Migraine and Proposed Diagnostic Criteria. JAMA network open, 6(5), e2313235. https://doi.org/10.1001/jamanetworkopen.2023.13235

@article{ed776b4ea0d5462eb0d2bf8b74142668,

title = "Population-Based Characterization of Menstrual Migraine and Proposed Diagnostic Criteria",

abstract = "Importance: There is a need for better recognition and more extensive research into menstrual migraine (MM) in the general population, and a revision of the diagnostic criteria for MM is warranted to move the field forward. Increased understanding of MM is crucial for improving clinical care, diagnosis, and therapy for MM. Objectives: To assess the clinical characteristics of MM, including severity and treatment response, and to propose new diagnostic criteria for pure MM and menstrually related migraine. Design, Setting, and Participants: This is a case-control study of Danish individuals with migraine. All individuals completed a 105-item validated diagnostic migraine questionnaire, sent via the Danish electronic mailing system (e-Boks) between May and August 2020, allowing diagnosis of pure MM and menstrually related migraine by the International Classification of Headache Disorders, Third Edition (ICHD-3). Data analysis was performed from September 2021 to November 2022. Exposure: Diagnosis of migraine. Main Outcomes and Measures: Clinical characteristics of women with MM and women with nonmenstrual migraine (non-MM) were compared using the ICHD-3 diagnostic criteria. A simulation of the risk of randomly misclassifying MM was based on number of migraine attacks during 3 menstrual cycles (3 × 28 days), and simulation analyses were performed using 100 000 permutations of random migraine attacks in migraine patients. Results: A total of 12 618 individuals, including 9184 women, with migraine participated in the study. Among the women with migraine, the prevalence of MM was 16.6% (1532 women), and the prevalence of non-MM was 45.9% (4216 women). The mean (SD) age was 38.7 (8.7) years for women with MM and 37.0 (9.2) years for women with non-MM. Of the 1532 women with MM, 410 (26.8%) fulfilled ICHD-3 diagnostic criteria for pure MM, 1037 (67.7%) fulfilled ICHD-3 diagnostic criteria for menstrually related migraine, and 152 (9.9%) fulfilled proposed diagnostic criteria for rare pure MM. MM was associated with a higher frequency of migraine-accompanying symptoms (odds ratio [OR], 1.98; 95% CI, 1.71-2.29), more frequent (OR, 7.21; 95% CI, 5.77-9.03) and more severe (OR, 1.17; 95% CI, 1.13-1.21) migraine attacks, lower frequency of nonmigraine headache (OR, 0.31; 95% CI, 0.18-0.49), an overall greater response to treatment with triptans (OR, 1.66; 95% CI, 1.24-2.24), better improvement of migraine attacks during late pregnancy (OR, 5.10; 95% CI, 2.17-14.00), and faster reappearance of migraine attacks post partum (OR, 3.19; 95% CI, 2.40-4.25). Hormonal contraceptive-related MM was associated with a higher prevalence of migraine without aura than migraine related to spontaneous menstruation (OR, 1.82; 95% CI, 1.62-2.06). Otherwise, no differences between hormonal and spontaneous MM were observed. The risk of random diagnostic misclassification of ICHD-3 menstrually related migraine in women with high frequency episodic migraine was 43%. This risk was reduced to 3% when applying the proposed criteria for menstrually related migraine. Conclusions and Relevance: In this case-control study, MM in the general population had clinical characteristics that were quantitively different from those of non-MM. Detailed descriptive data and suggested improved diagnostic criteria for pure MM and menstrually related migraine were provided.",

author = "Chalmer, {Mona Ameri} and Kogelman, {Lisette J.A.} and Henrik Ullum and Erik S{\o}rensen and Maria Didriksen and Susan Mikkelsen and Dinh, {Khoa Manh} and Thorsten Brodersen and Nielsen, {Kaspar R.} and Bruun, {Mie Topholm} and Karina Banasik and S{\o}ren Brunak and Christian Erikstrup and Pedersen, {Ole Birger} and Ostrowski, {Sisse Rye} and Jes Olesen and Hansen, {Thomas Folkmann}",

year = "2023",

month = may,

day = "1",

doi = "10.1001/jamanetworkopen.2023.13235",

language = "English",

volume = "6",

pages = "e2313235",

journal = "JAMA network open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "5",

}

Chalmer, MA, Kogelman, LJA, Ullum, H, Sørensen, E, Didriksen, M, Mikkelsen, S , Dinh, KM, Brodersen, T, Nielsen, KR, Bruun, MT, Banasik, K, Brunak, S, Erikstrup, C, Pedersen, OB, Ostrowski, SR, Olesen, J & Hansen, TF 2023, 'Population-Based Characterization of Menstrual Migraine and Proposed Diagnostic Criteria', JAMA network open, vol. 6, no. 5, pp. e2313235. https://doi.org/10.1001/jamanetworkopen.2023.13235

Population-Based Characterization of Menstrual Migraine and Proposed Diagnostic Criteria. / Chalmer, Mona Ameri; Kogelman, Lisette J.A.; Ullum, Henrik et al.
In: JAMA network open, Vol. 6, No. 5, 01.05.2023, p. e2313235.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Population-Based Characterization of Menstrual Migraine and Proposed Diagnostic Criteria

AU - Chalmer, Mona Ameri

AU - Kogelman, Lisette J.A.

AU - Ullum, Henrik

AU - Sørensen, Erik

AU - Didriksen, Maria

AU - Mikkelsen, Susan

AU - Dinh, Khoa Manh

AU - Brodersen, Thorsten

AU - Nielsen, Kaspar R.

AU - Bruun, Mie Topholm

AU - Banasik, Karina

AU - Brunak, Søren

AU - Erikstrup, Christian

AU - Pedersen, Ole Birger

AU - Ostrowski, Sisse Rye

AU - Olesen, Jes

AU - Hansen, Thomas Folkmann

PY - 2023/5/1

Y1 - 2023/5/1

N2 - Importance: There is a need for better recognition and more extensive research into menstrual migraine (MM) in the general population, and a revision of the diagnostic criteria for MM is warranted to move the field forward. Increased understanding of MM is crucial for improving clinical care, diagnosis, and therapy for MM. Objectives: To assess the clinical characteristics of MM, including severity and treatment response, and to propose new diagnostic criteria for pure MM and menstrually related migraine. Design, Setting, and Participants: This is a case-control study of Danish individuals with migraine. All individuals completed a 105-item validated diagnostic migraine questionnaire, sent via the Danish electronic mailing system (e-Boks) between May and August 2020, allowing diagnosis of pure MM and menstrually related migraine by the International Classification of Headache Disorders, Third Edition (ICHD-3). Data analysis was performed from September 2021 to November 2022. Exposure: Diagnosis of migraine. Main Outcomes and Measures: Clinical characteristics of women with MM and women with nonmenstrual migraine (non-MM) were compared using the ICHD-3 diagnostic criteria. A simulation of the risk of randomly misclassifying MM was based on number of migraine attacks during 3 menstrual cycles (3 × 28 days), and simulation analyses were performed using 100 000 permutations of random migraine attacks in migraine patients. Results: A total of 12 618 individuals, including 9184 women, with migraine participated in the study. Among the women with migraine, the prevalence of MM was 16.6% (1532 women), and the prevalence of non-MM was 45.9% (4216 women). The mean (SD) age was 38.7 (8.7) years for women with MM and 37.0 (9.2) years for women with non-MM. Of the 1532 women with MM, 410 (26.8%) fulfilled ICHD-3 diagnostic criteria for pure MM, 1037 (67.7%) fulfilled ICHD-3 diagnostic criteria for menstrually related migraine, and 152 (9.9%) fulfilled proposed diagnostic criteria for rare pure MM. MM was associated with a higher frequency of migraine-accompanying symptoms (odds ratio [OR], 1.98; 95% CI, 1.71-2.29), more frequent (OR, 7.21; 95% CI, 5.77-9.03) and more severe (OR, 1.17; 95% CI, 1.13-1.21) migraine attacks, lower frequency of nonmigraine headache (OR, 0.31; 95% CI, 0.18-0.49), an overall greater response to treatment with triptans (OR, 1.66; 95% CI, 1.24-2.24), better improvement of migraine attacks during late pregnancy (OR, 5.10; 95% CI, 2.17-14.00), and faster reappearance of migraine attacks post partum (OR, 3.19; 95% CI, 2.40-4.25). Hormonal contraceptive-related MM was associated with a higher prevalence of migraine without aura than migraine related to spontaneous menstruation (OR, 1.82; 95% CI, 1.62-2.06). Otherwise, no differences between hormonal and spontaneous MM were observed. The risk of random diagnostic misclassification of ICHD-3 menstrually related migraine in women with high frequency episodic migraine was 43%. This risk was reduced to 3% when applying the proposed criteria for menstrually related migraine. Conclusions and Relevance: In this case-control study, MM in the general population had clinical characteristics that were quantitively different from those of non-MM. Detailed descriptive data and suggested improved diagnostic criteria for pure MM and menstrually related migraine were provided.

AB - Importance: There is a need for better recognition and more extensive research into menstrual migraine (MM) in the general population, and a revision of the diagnostic criteria for MM is warranted to move the field forward. Increased understanding of MM is crucial for improving clinical care, diagnosis, and therapy for MM. Objectives: To assess the clinical characteristics of MM, including severity and treatment response, and to propose new diagnostic criteria for pure MM and menstrually related migraine. Design, Setting, and Participants: This is a case-control study of Danish individuals with migraine. All individuals completed a 105-item validated diagnostic migraine questionnaire, sent via the Danish electronic mailing system (e-Boks) between May and August 2020, allowing diagnosis of pure MM and menstrually related migraine by the International Classification of Headache Disorders, Third Edition (ICHD-3). Data analysis was performed from September 2021 to November 2022. Exposure: Diagnosis of migraine. Main Outcomes and Measures: Clinical characteristics of women with MM and women with nonmenstrual migraine (non-MM) were compared using the ICHD-3 diagnostic criteria. A simulation of the risk of randomly misclassifying MM was based on number of migraine attacks during 3 menstrual cycles (3 × 28 days), and simulation analyses were performed using 100 000 permutations of random migraine attacks in migraine patients. Results: A total of 12 618 individuals, including 9184 women, with migraine participated in the study. Among the women with migraine, the prevalence of MM was 16.6% (1532 women), and the prevalence of non-MM was 45.9% (4216 women). The mean (SD) age was 38.7 (8.7) years for women with MM and 37.0 (9.2) years for women with non-MM. Of the 1532 women with MM, 410 (26.8%) fulfilled ICHD-3 diagnostic criteria for pure MM, 1037 (67.7%) fulfilled ICHD-3 diagnostic criteria for menstrually related migraine, and 152 (9.9%) fulfilled proposed diagnostic criteria for rare pure MM. MM was associated with a higher frequency of migraine-accompanying symptoms (odds ratio [OR], 1.98; 95% CI, 1.71-2.29), more frequent (OR, 7.21; 95% CI, 5.77-9.03) and more severe (OR, 1.17; 95% CI, 1.13-1.21) migraine attacks, lower frequency of nonmigraine headache (OR, 0.31; 95% CI, 0.18-0.49), an overall greater response to treatment with triptans (OR, 1.66; 95% CI, 1.24-2.24), better improvement of migraine attacks during late pregnancy (OR, 5.10; 95% CI, 2.17-14.00), and faster reappearance of migraine attacks post partum (OR, 3.19; 95% CI, 2.40-4.25). Hormonal contraceptive-related MM was associated with a higher prevalence of migraine without aura than migraine related to spontaneous menstruation (OR, 1.82; 95% CI, 1.62-2.06). Otherwise, no differences between hormonal and spontaneous MM were observed. The risk of random diagnostic misclassification of ICHD-3 menstrually related migraine in women with high frequency episodic migraine was 43%. This risk was reduced to 3% when applying the proposed criteria for menstrually related migraine. Conclusions and Relevance: In this case-control study, MM in the general population had clinical characteristics that were quantitively different from those of non-MM. Detailed descriptive data and suggested improved diagnostic criteria for pure MM and menstrually related migraine were provided.

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U2 - 10.1001/jamanetworkopen.2023.13235

DO - 10.1001/jamanetworkopen.2023.13235

M3 - Journal article

C2 - 37184838

AN - SCOPUS:85159733390

SN - 2574-3805

VL - 6

SP - e2313235

JO - JAMA network open

JF - JAMA network open

IS - 5

ER -

Population-Based Characterization of Menstrual Migraine and Proposed Diagnostic Criteria

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