Manifestation of Migraine in Adolescents: Menstrual Cycle- Dependance und Characteristics

Aims: Headaches occur with the same frequency in male and female children. After the onset of puberty, headaches are markedly more prevalent in females, representing a possible relation to hormonal fluctuations. This prospective pilot study aims to investigate the menstrual cycle dependence of migraine headaches and the incidence of specific characteristics in adolescent female patients.

Materials and Methods: Female patients between 7 and 18 years old, referred with headaches that met International Classification of Headache Disorders II diagnostic criteria for migraine without aura, kept a daily headache and menstrual cycle diary over 8 weeks. Ovulating cycles were identified with weekly progesterone saliva tests. According to the clinical Tanner-stage and the onset of a regular menstruation, three groups were formed: pre-, peri-, and postpubertal. The statistical evaluation was performed with SPSS. Wilcoxon Signed-Ranks Test was used on ranked data regarding migraine episode frequency in different menstrual cycle phases. p- Values < .05 were considered statistically significant.

Results: The study population consisted of 55 females, 16 were grouped as prepubertal, 20 as peripubertal and 19 as postpubertal. Over 8 weeks, patients reported 142 headache days prepubertal (Mean =  8.88, SD=9.266), 189 days peripubertal (Mean = 9.95, SD= 9.484) and 538 days postpubertal (Mean = 29.89, SD= 19.007). A significant higher frequency of migraine episodes was noted in the postpubertal patient group in comparison to both other patient groups (p<.001). Among the groups no significant differences regarding the headache characteristics, maximal headache duration and accompanying symptoms were noted. A menstrual cycle dependance with the cycle calender and the progesterone levels was found in 17 girls: 13 girls were found to have a higher frequency of migraine episodes in the follicular phase whereas four girls were found to suffer from migraines more frequently in the luteal phase (p = .021).

Discussion: The combination of Tanner stage, onset of menstruation and the analysis of ovulatory cycles by means of progesterone saliva measurements allows in contrast to a mere age classification a more reliable allocation of the pubertal development stage. A better cycle dependence could be analyzed with hormone measurements which would have been a more invasive method. Characteristics did not differ significantly which possibly is a sign for individual characteristics rather than for patterns associated with certain hormonal conditions.

Conclusion: The number of migraine attacks but not the specific characteristics differ among the pre-, peri- and postpubertal female patient groups which should be taken into consideration regarding the management of the afore mentioned patients.

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