Understanding and diagnosing menstrually related migraine

Approximately 60% of migraine headaches in women are associated with the menstrual cycle, with 25% of menstrually related migraines occurring exclusively during the perimenstrual period and 75% occurring during this period as well as at other times during the cycle. Both types of menstrually associated migraine fall under the broader classification of migraine without aura, and typically last longer and may require more treatment than migraines with aura. This article reviews the hormonal fluctuations that occur during the natural menstrual cycle, pregnancy, perimenopause, and menopause, as well as their relationship to migraine attacks. Epidemiology, impact, characteristics, and complex pathophysiology of menstrually related migraine are reviewed along with diagnostic criteria and a discussion of the links between migraine and numerous comorbid conditions. Whereas comorbidities can confound the diagnosis, they more directly influence choice of medication for treatment.