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Migraine headaches associated with menses are common and well documented among women, but data in adolescents are limited, especially related to age of migraine onset and menarche. To describe menstruation-associated migraine in adolescents, investigators retrospectively reviewed data from a standardized headache questionnaire that was completed by 896 consecutive girls (mean age, 14 years; 82% white) at their initial referral visit to a pediatric headache center in Cincinnati.
More than 90% of girls met the International Classification of Headache Disorders 2nd Edition criteria for migraine, and more than half described having menstruation-related migraine (menstrual migraines or migraines with a monthly pattern even if menses are irregular or have not begun). Among girls aged 9 to 12 years, only 13% had reached menarche, yet 25% reported a monthly pattern to their headaches. As expected, 95% of girls aged 14 years had started menstruating; 47% of them described menstruation-associated migraines. Among the subset of 121 girls who reported migraine associated with their menstrual periods, half reported headache onset 2 days before menses, 36% reported onset 1 day before or on the day menses began, and 14% reported onset after menses started. Headaches worsened during 75% of menstrual periods. Nearly all girls with menstruation-associated migraine headache reported pulsating quality, photophobia, and phonophobia; 72% reported nausea; and 58% reported pressure. Half the girls described menstrual migraines as unilateral and half described them as frontal.
Crawford MJ et al. Menstrual migraine in adolescents. Headache 2009 Mar; 49:341.
Comment
These data might overstate the severity of menstruation-associated migraine because they were obtained from patients seen at a referral headache center and because “not sure” and “yes” questionnaire responses were grouped together. Nonetheless, the findings are consistent with those in adult women. Given that menarche and regular menses occur relatively late in puberty (menarche starts within a few years after onset of breast development), the finding that many younger girls reported a monthly pattern to their headaches before menses began or became regular is not surprising. Girls who can predict headache onset could take nonsteroidal anti-inflammatory drugs, which are often effective for treating migraines and provide the added benefit of relieving dysmenorrhea, if present. Extended cycling with oral contraceptives can also reduce headache frequency.