Mid-Cycle Headaches and Their Relationship to Different Patterns of Premenstrual Stress Symptoms


  • Funding: Funding and support for this study was provided by an Innovative Research Grant from the Università Degli Studi di Padova. The University had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
  • Conflict of Interest: J. Kiesner declares no conflict of interests of any kind in relation to this publication. Dr. Martin declares the following conflicts of interest: Allergan – consultant, speaker; Zogenix – consultant, speaker; MAP – consultant; Nautilus – consultant; GSK – grant.

Address all correspondence to J. Kiesner, Università degli Studi di Padova – Dipartimento di Psicologia DPSS, via Venezia 8 Padova PD 35131, Italy, email: jeff.kiesner@unipd.it



Recent research has shown that affective changes associated with the menstrual cycle may follow diverse patterns, including a classic premenstrual syndrome pattern, as well as the mirror opposite pattern, referred to as a mid-cycle pattern.


Test for the presence of a mid-cycle pattern of headaches, in addition to a menstrual pattern and a noncyclic pattern; test for an association between experiencing a specific pattern of headaches and a specific (previously identified) pattern of depression/anxiety; and test for mean-level differences, across headache pattern groups, in average headache index and depression/anxiety scores (averaged across 2 menstrual cycles for each participant).


A sample of 213 female university students completed daily questionnaires regarding symptoms of headaches and depression/anxiety for 2 menstrual cycles. Hierarchical linear modeling, polynomial multiple regression, analyses of variance, and chi-square analyses were used to test the hypotheses.


Confirmed the existence of a mid-cycle pattern of headaches (16%), in addition to a menstrual pattern (51%), and a noncyclic pattern of headaches (33%). Patterns of headaches and affective change were significantly associated (χ2 = 21.33, P = .0003; 54% correspondence), as were the average headache index and depression/anxiety scores (r = .49; P < .0001). No significant mean-level differences were found between the headache pattern groups on the average headache index scores or depression/anxiety scores.


A significant number of women experience a mid-cycle pattern of headaches during the menstrual cycle. Moreover, women often, but not always, demonstrate the same pattern of headaches and depression/anxiety symptoms.