Presenting a New, Non‐Hormonally Mediated Cyclic Headache in Women: End‐Menstrual Migraine

Abstract

EMM is a common complaint in women evaluated for menstrual-related migraine (MRM), yet these migraines occur many days after the estrogen withdrawal that precipitates MRM. The authors do not believe that EMM is hormonally mediated, but rather that it is causally related to menstrual blood loss, resulting in a brief relative anemia with consequent migraine. Further study is needed to substantiate this association, search for confounders, and evaluate response to iron therapy.

Triggers, Protectors, and Predictors in Episodic Migraine

“…Estrogen withdrawal prior to menses is likely the cause of menstrual migraine and explains why migraine onset often commences prior to menstruation onset or on the first day (65). For a significant minority of women, menstrual-related migraine may be more likely to occur towards the end of their cycle suggesting a relationship to blood loss or anemia (66).…”

Prevalence of menstrually-related migraine in a population of students from a municipal university center in the interior of Brazil

“…The migraine related to the end of menstruation is a common complaint in women that have migraine related to the menstrual period, but it occurs many days after the removal of estrogen, apparently not being mediated by hormonal levels. 11 Calhoun et al 11 believe that this kind of migraine is related to the relative loss of blood, resulting in a short anemia. Moreover, it was recently been demonstrated that the late menstrual phase migraine seems to be related to ferritin levels.…”

“…Moreover, it was recently been demonstrated that the late menstrual phase migraine seems to be related to ferritin levels. 11 In Brazil, studies on migraine and women are scarcely seen, one of them is the Melhado's one. 9 Studies on menstrual migraine are uncommon as well, especially in specific populations like female university students.…”