by Huma U. Sheikh, MD

Menstrually-related migraine is an important subset of patients with migraine. Migraine around this time are typically very difficult to treat and can be particularly severe. The diagnosis is based on the timing of migraine, when it is in a 5 day perimenstrual window. However, there can be a huge variation not only between patients but as well as in the patient itself, in between cycles.

There was a recent study that looked at data from a digital platform, N1-Headache. This is a digital health platform where patients can enter data and it can help to discover personal triggers for migraine, allowing for more personalized care. The platform also allows clinicians to use the data for better management and objective data. It works as an app, developed with the help of a neurologist developed with the digital healthcare company, Curelator.

In the study, there was data from daily migraine and menstruation status added into the app over a 90 day period. Some of the main information that was recorded included migraine day and menstrual status. The data was analyzed over a longitudinal period using three-level binary models.

Some of the main findings included that there is a lot of variability within and across women on how their perimenstrual status plays on their migraine. There was more variation within women than between women. The previous association of increase in migraine in the perimenstrual window was verified again in this study.

This is an important study that can help to guide how patients are treated. Asking about perimenstrual association is a critical question to ask of all women who present with migraine. If there is not a clear association, using a headache diary or an app such as this one can be helpful in providing clear and more objective data in determining triggers as well as if there is a clear menstrual association. This can be important in determining treatment strategies.

There may be two major patterns for menstrual migraine, one where the majority of migraine are at that time. In the other instance, there may be menstrual association but migraine are also present at other times of month. Helping to make this distinction can be helpful in dictating treatment. For most who only have menstrually related migraine, a mini-prophylaxis may be adequate in providing relief. This can help to avoid more extensive preventive therapy which may come with side effects and other complications. The app can be very helpful in dictating treatment and helping to put patients in charge of their treatment and disease.