198 Headache Medicine, v.3, n.4, p.198-235, Oct./Nov./Dec. 2012

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BACKGROUND

Although migraine is more common in women than

in men,

(1)

it is yet little explored whether migraine, migraine

types, or headache frequency are linked to specific events

of the reproductive cycle. Since particular migraine sub-

types seem to be risk factor for more serious diseases (e.g.

cardiovascular disease),

(2)

the topic is of relevance.

OBJECTIVES

To contrast aspects related to women's reproductive

cycle (age of menarche, number of pregnancies,

headaches during pregnancy, menstrual cycle, duration

of period, use of contraceptive pills) as a function of

headache status and of headache type.

METHODS

Sample consisted of 422 college students. A structured

questionnaire was used, allowing the classification of the

headaches according to the second edition of the

International Classification for Headache Disorders.

(3)

Information about reproductive life was obtained (use of

contraceptive pills, age of menarche, duration of period,

menstrual cycle, headaches during pregnancy, number

of pregnancies).

Questionnaire consisted of 44 questions divided in 3

parts. Part 1 assessed demographics. Part 2 (22 questions)

obtained detailed headache information. Part 3 (10

questions) explored temporality of headache relative to

the menstrual cycle, and aspects related to fertility and

reproductive life. Pregnant women and women younger

than 18 or older than 45 years were excluded.

Menstrual headache was defined as headaches

happening from two days before the first day of

menstruation until the third day of the period. It was divided

in pure (not happening in other times) or related. Findings

were contrasted as a function of headache type.

The study was approved by an academically affiliated

Investigation Review Board, and consent forms were

obtained (Conselho de Ética em Pesquisa-FIPA, nº 38/

10 de 14/6/2010).

RESULTS

Median age of the participating sample was 22

years. Of participants, 27.9% had migraine without aura

(MO), 17.8% had migraine with aura (MA), 16.9% had

probable migraine (PM), 6.8% had chronic daily

headaches (CDH), 3.1% had tension-type headache

(TTH) and 6.6% had other headache types.

Figure 1 displays the age of menarche as a function

of current headache status. Overall, median age of

Headache type and aspects of reproductive life

in young women

Eliana Meire Melhado

, Andressa Regina Galego

, João Paulo Galdezzani

Luiz Paulo de Queiroz

, Marcelo Eduardo Bigal

MD, PhD. Department of Neurology – Unicamp. Head of Padre Albino Integrated Colleges,

Department of Neurology, Catanduva, São Paulo, Brazil

College students of Padre Albino Integrated Colleges (Medical School), Catanduva, SP, Brazil

MD, PhD. Department of Neurology – Unifesp, São Paulo, SP, Brazil

M.D., Ph.D. Head of the Merck Investigator Studies Program, Scientific Engagements and Education

(MISP/SEE) Office of the Chief Medical Officer – Merck North Wales, PA, USA

Melhado EM, Galego AR, Galdezzani JP, Queiroz LP, Bigal ME. Headache type and aspects of

reproductive life in young women. Headache Medicine. 2012;3(4):198-9

Headache Medicine, v.3, n.4, p.198-235, Oct./Nov./Dec. 2012 199

menarche was 12.3 years. As seen, women with MA were

significantly more likely to have had their menarche at earlier

ages than women without headaches (p = 0.03) (Figure 1).

Women with CDH were significantly more likely than

women with episodic migraine or with no headaches to

have longer menstrual periods (7 days or more, p < 0.05).

Use of hormonal contraceptive pills was strikingly similar

as a function of having or not migraine headaches, having

or not aura, and as a function of number of headache

days per month (around 73% for all groups) (Table 1).

Pregnancy modified the phenotype of the headache

quite considerably. The relative frequency of CDH and of

MA was significantly increased during pregnancy relative

to outside of pregnancy (p < 0.01) (Figure 2).

CONCLUSIONS

The fact that women with MA are equally likely to

receive hormonal contraceptives relative to women without

headaches or with other headache types raise the question

whether providers are properly assessing risk of

cardiovascular

(2)

outcomes in some women with

headaches. Since we did not assess body mass index or

tabagism, we can't infer on properness of care. We did

however expect lower proportion of women with MA to

be using hormonal medications.

Although headaches tend to improve during

pregnancy

(4-6)

relative frequency of aura or frequent

headaches is increased in pregnancy relative to outside

pregnancy. Reasons for this change need to be further

explored. Studies should also focus on whether these

headache types are associated with complications during

pregnancy.

Finally, the finding that the duration of the menstruation

varied as a function of headache frequency also raises

the suspicion that hormonal fluctuations not only relate to

the prevalence of migraine, but also to the frequency of

headaches.

REFERENCES

1. Macgregor EA, Rosenberg JD, Kurth T. Sex-related differences in

epidemiological and clinic-based headache studies. Headache.

2011;51:843-859.

2. Bigal ME, Kurth T, Santanello N, Buse D, Golden W, Robbins M,

Lipton RB. Migraine and cardiovascular disease. A population-

based study. Neurology. 2010; 74:628-35.

3. Headache Classification Subcommittee of the International

Headache Society. The International Classification of Headache

Disorders (2nd ed.). Cephalalgia. 2004; 24(Suppl1): 1-151.

4. Melhado EM, Maciel JA, Guerreiro CA. Headache during

gestation: evaluation of 1101 women. Can J Neurol Sci.

2007;34(2):187-92.

5. Sances G, Granella F, Nappi RE, Fignon A, Ghiotto N, Polatti F et

al. Course of migraine during pregnancy and postpartum: a

prospective study. Cephalalgia; 2003; 23(3):197-205.

6. Rasmussen BK. Migraine and tension-type headache in a general

population: precipiting factores, female hormones, sleep pattern

and relation to lifestyle. Pain; 1993; 53:65-72.

Figure 1 – Age of menarche as a function of headache type. PM =

Probable migraine; MO = Migraine without aura; MA = Migraine

with aura; CDH = Chronic daily headache

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Figure 2 – Headache diagnoses (the Second Edition of the International

Classification for Headache Disorders) as a function of pregnancy.