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Clinical differences between menstrual migraine and nonmenstrual migraine: a systematic review and meta-analysis of observational studies

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Abstract

Background and purpose

Approximately 60% of female migraineurs experience menstrual migraine (MM). Whether MM is a distinct clinical entity with more severe migraine attacks and a worse prognosis than nonmenstrual migraine (nMM) is still under debate. We conducted a systematic review and meta-analysis to investigate clinical differences between MM and nMM patients.

Methods

A systematic literature search was performed to identify observational studies comparing MM and nMM patients’ clinical characteristics. Quality of evidence grades of the synthesized effect estimates for each outcome were determined following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

Results

Of 1837 identified studies, 16 were eligible for inclusion. MM patients had more migraine attacks per month (MD 0.65, 95% CI 0.05–1.24) than nMM patients; however, the quality of evidence was “low” according to the GRADE assessment. They also had more headache days (MD 0.86, 95% CI 0.12–1.60) per month, a higher rate of family history of migraine (OR 1.41 95% CI 1.12–1.78), migraine aggravation with physical activity (OR 1.60, 95% CI 1.35–1.89), a younger age at migraine onset (MD − 0.99, 95% CI − 1.78 to − 0.19), and a higher risk of accompanying symptoms (OR 2.31, 95% CI 1.72–3.10) than nMM patients; however, the quality of evidence was “very low”.

Conclusions

There were differences between MM and nMM, showing that MM patients have a worse profile than nMM patients, but the quality of evidence is too low to draw definite conclusions on the separation/unification of the two clinical entities.

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Availability of data and materials

Most of analyzed data were included in this manuscript and supplemental materials.

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Funding

The present study was supported by Yunnan Fundamental Research Project (Grant No. 202001AT070127).

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Authors and Affiliations

  1. Department of Neurology, The Affiliated Hospital of Yunnan University, No. 176 Qingnian Road, Kunming, 650021, Yunnan Province, People’s Republic of China

    Miao Wang, Guoliang Zhu, Zhenyu Song & Fanyi Kong

  2. School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China

    Miao Wang

  3. School of Clinical Medicine, Dali University, Dali, Yunnan Province, People’s Republic of China

    Guoliang Zhu

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  1. Miao Wang
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  4. Fanyi Kong
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Contributions

MW and FK contributed to interpretation of the data, drafting the original manuscript, and the conception and design of this meta-analysis. MW and GZ contributed to literature search and selection, data extraction, data analysis, and literature quality assessment. MW, ZS, and FK contributed to drafting the figures and tables and revision of the manuscript. All the authors have given final approval of the version of the manuscript to be published.

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Correspondence to Fanyi Kong.

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Wang, M., Zhu, G., Song, Z. et al. Clinical differences between menstrual migraine and nonmenstrual migraine: a systematic review and meta-analysis of observational studies. J Neurol 270, 1249–1265 (2023). https://doi.org/10.1007/s00415-022-11477-1

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  • DOI: https://doi.org/10.1007/s00415-022-11477-1

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