Migraine Prevalence in Women with Endometriosis
Yes, migraines are notably common in women with endometriosis, occurring in approximately 35-53% of affected women—roughly 2 to 4 times higher than in women without endometriosis.
Epidemiological Evidence
The association between endometriosis and migraine is well-established across multiple high-quality studies. Women with surgically confirmed endometriosis demonstrate migraine prevalence rates of 38-53%, compared to 12-17% in control populations 1, 2, 3. This represents a significant odds ratio of 2.25 (95% CI 1.85-2.72) based on meta-analysis of over 330,000 individuals 4.
The most recent and robust evidence from a 2026 multicenter cross-sectional study of 838 women found that 41.0% of women with surgically confirmed endometriosis had migraine versus 32.5% without surgical confirmation (OR 1.44,95% CI 1.07-1.95), maintaining significance after adjustment for age, BMI, education, and hormonal therapy 1.
Migraine Subtypes and Clinical Patterns
Among women with endometriosis who experience migraine, the distribution breaks down as follows:
- Non-menstrual migraine: 36-64% of migraineurs
- Menstrually-related migraine: 29-46% of migraineurs
- Pure menstrual migraine: 7-19% of migraineurs
Migraine with aura shows particularly strong association with endometriosis (OR 1.61,95% CI 1.11-2.35), as does pure menstrual migraine (OR 11.27,95% CI 1.51-84.01) 1. Women with endometriosis also experience migraine onset at significantly younger ages (16.4 years) compared to controls (21.9 years) 5.
Relationship to Endometriosis Severity
The strength of the migraine-endometriosis association increases with disease severity. Women with severe endometriosis show 4.6-fold increased odds of migraine (OR 4.6,95% CI 2.7-8.1), while moderate stage shows 3.6-fold odds (OR 3.6,95% CI 2.1-6.2) 6. The association is particularly pronounced when endometriosis co-occurs with adenomyosis (OR 5.4,95% CI 3.0-9.5) 6.
Specific endometriosis phenotypes matter: ovarian endometrioma and deep infiltrating endometriosis show significant associations with migraine (OR 2.78,95% CI 1.11-6.98 and OR 2.51,95% CI 1.25-5.07, respectively), while superficial peritoneal endometriosis does not 3.
Clinical Implications
Women with both conditions experience greater symptom burden. Menstrually-related migraine associates with higher migraine frequency, pain intensity, and functional impairment compared to other migraine subtypes 1. Additionally, women with endometriosis and migraine report significantly greater chronic non-cyclical pelvic pain (VAS 3.6±2.9) compared to those without migraine (VAS 2.3±2.8) 3.
Importantly, in 85.7% of cases, migraine symptoms begin years before endometriosis diagnosis 2, suggesting migraine may serve as an early clinical marker warranting endometriosis screening in reproductive-age women.
Pathophysiological Context
While the 2023 Hypertension guidelines note that endometriosis affects 2-10% of women of childbearing age and induces chronic inflammation, chronic pelvic pain, and dysmenorrhea 7, the mechanism linking endometriosis to migraine appears rooted in shared genetic architecture and convergent inflammatory pathways rather than simple causation. Mendelian randomization analyses refute direct causality, instead pointing to pleiotropy involving shared risk loci (TRIM32, SLC44A4) that converge on dysregulated IL-1, TNF-α, and MAPK/ERK signaling pathways 8.
Clinical Screening Recommendations
Women of reproductive age presenting with migraine—particularly migraine with aura or menstrually-related patterns—should be systematically screened for endometriosis criteria including dysmenorrhea, dyspareunia, dyschezia, dysuria, and infertility 3. Conversely, women diagnosed with endometriosis warrant formal headache assessment using validated criteria to identify migraine requiring specific management 2.
The ACR Appropriateness Criteria note that endometriosis impacts approximately 10% of individuals assigned female at birth, with pelvic pain as the most common symptom 9. Given the 2-4 fold increased migraine prevalence, this represents a substantial comorbidity burden requiring integrated clinical attention.