Migraine Is Associated With Menorrhagia and Endometriosis


  • Gretchen E. Tietjen MD,

  • Anita Conway MD, MPH,

  • Christine Utley MSN,

  • William T. Gunning PhD,

  • Nabeel A. Herial MD, MPH

  • From the Department of Neurology (Drs. Tietjen, Conway, and Herial and Ms. Utley); Department of Pathology, Medical College of Ohio, Toledo, OH (Dr. Gunning).

Address all correspondence to Dr. Gretchen Tietjen, Medical College of Ohio, Department of Neurology, 3120 Glendale Avenue, Toledo, OH 43614.


Objective.—To evaluate the frequency of menorrhagia and endometriosis in female migraineurs compared to age-matched women without headache.

Background.—Migraine predominantly affects women of childbearing age and is often associated with the menstrual period, yet there is a paucity of data regarding the relationship of migraine and menstrual disorders.

Methods.—Women diagnosed with migraine, using International Headache Society criteria and an age- and sex-matched control group, were administered a semistructured questionnaire regarding migraine and migraine-related disability, menstrual history, other bleeding history, vascular event history, and vascular risk factors.

Results.—Fifty female migraineurs between the ages of 22 and 50 years and 52 age-matched women (mean age 37 years) were enrolled in the study. Similar proportions of women in each group reported using hormone contraceptives (30% vs. 33%, P= .77) and hormone replacement therapy (12% vs. 8%, P= .69). The proportions presently menstruating (64 % vs. 80%, P= .20) and status after hysterectomy were similar (24% vs. 14%, P= .84). Menorrhagia (defined as at least three consecutive heavy periods), both current and prior, was more commonly reported in migraineurs (63% vs. 37%, P= .009), with higher likelihood of staining clothes by menses (35% vs. 8%, P= .003), and significant impact of menses on activities of daily living (on a 10-point Likert scale) with work/school participation (P= .02), family activities (P < .0001), sleep (P= .003), life enjoyment (P= .001), mood (P= .02), and overall quality of life (P= .003). Endometriosis, which may be associated with menorrhagia, was also more commonly diagnosed in the migraineurs (30% vs. 4%, P= .001). The migraineurs more frequently described bruising (40% vs. 10%, P < .001) and rectal bleeding (18% vs. 2%, P= .017) but not more serious bleeding problems. Nonsteroidal anti-inflammatory drug (NSAID) use was more frequent in the migraine group (28% vs. 12%, P= .036), and significance for increased menorrhagia, endometriosis, menstrual interference, and bruising was maintained, even when controlling for the use of NSAIDs. With logistic regression, menorrhagia was significantly associated with migraine, adjusted odds ratio (OR) = 2.8 (95% CI 1.2 to 6.5), and with endometriosis, adjusted OR = 10.5 (95% CI 2.2 to 51.4). There were no differences in vascular events and risk factors, except for trends of increased hypertension (25% vs. 10%, P= .05), transient ischemic attack/stroke (10% vs. 2%, P= .08), and Raynaud's disease (10% vs. 2%, P= .08) in the migraineurs.

Conclusion.—Women with migraine have a higher frequency of menorrhagia, endometriosis, and associated psychosocial consequences. These findings suggest that there should be further study of factors influencing endometriosis and menstrual blood flow, such as eicosanoids and platelet function, in migraineurs.