Official Terminology for Menstrual Migraine
The official terms are "pure menstrual migraine" and "menstrually-related migraine" as defined by the International Classification of Headache Disorders (ICHD), though these remain in the appendix as research criteria requiring validation 1, 2.
Diagnostic Definitions
The ICHD distinguishes between two specific entities:
Pure Menstrual Migraine: Migraine occurring exclusively on day 1 ± 2 of menstruation in at least two out of three menstrual cycles, with NO attacks at other times in the cycle 1
Menstrually-Related Migraine: Migraine occurring on day 1 ± 2 of menstruation in at least two out of three cycles, BUT also occurring at other times during the menstrual cycle 1
Important Clinical Context
The term "menstrual migraine" (MM) or "catamenial migraine" are commonly used interchangeably in clinical practice and literature 1, 3. However, these terms lack precise standardization and are often misused by both patients and clinicians 4.
Key Caveats:
- These diagnostic criteria remain primarily research criteria rather than fully validated clinical diagnostic criteria 2
- The loose interpretation of these criteria has led to conflicting results in prevalence studies and treatment trials 3
- Some experts have proposed that "estrogen withdrawal migraine" may be a more mechanistically accurate term, as the timing (day 1 ± 2) is consistent with estrogen withdrawal as the trigger 4
Clinical Prevalence:
Menstrual migraine affects approximately 20-25% of female migraineurs in the general population and 22-70% of patients presenting to headache clinics 3. Recent guidelines acknowledge the presence of menstrual migraine as a clinically relevant subtype when considering treatment approaches 5.