From the Guidelines
To diagnose menstrual migraines, it is essential to start by maintaining a headache diary for at least 3 months to track the timing and characteristics of headaches in relation to the menstrual cycle, as recommended by 1.
Diagnostic Approach
A diagnosis of menstrual migraine can be made if headaches occur within 2 days before to 3 days after the onset of menstruation, with at least 2 of the following features:
- Unilateral pain
- Pulsating quality
- Moderate to severe intensity
- Aggravation by routine physical activity
- Association with nausea, vomiting, photophobia, or phonophobia.
Evaluation and Testing
A physical examination and medical history should also be conducted to rule out other potential causes of headaches, as suggested by 1. Laboratory tests such as a complete blood count, blood chemistry, and thyroid function tests may be ordered to exclude underlying conditions that could be contributing to the headaches. Imaging studies like MRI or CT scans may be considered if there are red flags such as sudden onset of severe headache, fever, confusion, or weakness, as indicated by 1.
Screening Instruments
Validated screening instruments, such as the ID-Migraine questionnaire or the Migraine Screen Questionnaire (MS-Q), can facilitate diagnosis, as discussed in 1. These instruments have been shown to have high sensitivity and specificity in diagnosing migraine, with the MS-Q having a sensitivity of 0.93 and a specificity of 0.81, as reported in 1.
Treatment Considerations
In terms of treatment, medications such as frovatriptan 2.5mg or naratriptan 1mg taken at the onset of headache and repeated as needed, or preventive treatments like estradiol gel 1.5mg or sumatriptan 25mg taken twice a day starting 2 days before the expected onset of menstruation and continuing for 5-7 days, may be prescribed, as mentioned in 1. Perimenstrual preventive treatment, such as daily intake of a long-acting NSAID or triptan for 5 days, beginning 2 days before the expected first day of menstruation, may also be considered, as suggested by 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnostic Approach for Menstrual Migraines
The diagnostic approach for menstrual migraines involves several steps, including:
- Identifying the relationship between migraine and menstruation using diagnostic systems such as the International Classification of Headache Disorders (ICHD-II) criteria or a probability model called Probability MM 2
- Using prospective headache diaries to record migraine patterns and determine the predictable patterns associated with menstrual migraine 2, 3
- Evaluating the characteristics of menstrual migraine, including functional disability, increased headache severity, and lack of aura 3
Classification of Menstrual Migraines
Menstrual migraines can be classified into two categories:
- Pure menstrual migraine: defined as a migraine occurring exclusively on day 1 ± 2 of menstruation in at least two out of three menstrual cycles and at no other time in the cycle 4
- Menstrually-related migraine: defined as a migraine that occurs during menstruation, but may also occur at other times in the menstrual cycle 4, 5
Diagnostic Criteria
The diagnostic criteria for menstrual migraine include:
- A relationship between migraine and menstruation, as determined by prospective headache diaries or diagnostic systems such as ICHD-II or Probability MM 2
- Characteristics of menstrual migraine, including functional disability, increased headache severity, and lack of aura 3
- Exclusion of other headache disorders, such as migraine without aura or migrainous disorder 6
Diagnostic Tools
Diagnostic tools for menstrual migraine include:
- Prospective headache diaries to record migraine patterns and determine the predictable patterns associated with menstrual migraine 2, 3
- Diagnostic systems such as ICHD-II or Probability MM to evaluate the relationship between migraine and menstruation 2
- Patient-reported symptoms and medical history to evaluate the characteristics of menstrual migraine and exclude other headache disorders 6, 3