Some women develop migraine headaches in relation to their menstrual cycle.
Classification:
(1) migraine headache limited to menstrual period ("pure", PMM)
(2) migraine headache during menstrual period and at other time ("menstrual related", MRM)
The attacks should occur in all or most (at least 2 out of 3) consecutive menstrual cycles, with onset and termination timed relative to the first day of menstruation (MacGregor 2007, Mathew et al 2013). The use of a headache symptom diary can help demonstrate the temporal relationships.
Times associated with falling blood estrogen levels (perimenstrual phase, postnatal period, etc) may trigger or make headaches worse.
Oral contraceptive-induced amenorrhea or estrogen replacement may make the headaches better.
Other causes of headache need to be excluded before the diagnosis is made.
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