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A Prospective Comparison Between ICHD-II and Probability Menstrual Migraine Diagnostic Criteria

Authors

  • Dawn A. Marcus MD,

    1. From the Department of Anesthesiology & Critical Care Medicine (D.A. Marcus, C.D. Bernstein, E.A. Sullivan, and T.E. Rudy), Department of Psychiatry (T.E. Rudy), Department of Biostatistics, University of Pittsburgh School of Medicine (T.E. Rudy), Pittsburgh, PA, USA.
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  • Cheryl D. Bernstein MD,

    1. From the Department of Anesthesiology & Critical Care Medicine (D.A. Marcus, C.D. Bernstein, E.A. Sullivan, and T.E. Rudy), Department of Psychiatry (T.E. Rudy), Department of Biostatistics, University of Pittsburgh School of Medicine (T.E. Rudy), Pittsburgh, PA, USA.
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  • Erin A. Sullivan MD,

    1. From the Department of Anesthesiology & Critical Care Medicine (D.A. Marcus, C.D. Bernstein, E.A. Sullivan, and T.E. Rudy), Department of Psychiatry (T.E. Rudy), Department of Biostatistics, University of Pittsburgh School of Medicine (T.E. Rudy), Pittsburgh, PA, USA.
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  • Thomas E. Rudy PhD

    1. From the Department of Anesthesiology & Critical Care Medicine (D.A. Marcus, C.D. Bernstein, E.A. Sullivan, and T.E. Rudy), Department of Psychiatry (T.E. Rudy), Department of Biostatistics, University of Pittsburgh School of Medicine (T.E. Rudy), Pittsburgh, PA, USA.
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  • Conflict of Interest: This study was supported by a grant from Pfizer. There are no additional conflicts to report.

D.A. Marcus, Suite 400, Pain Medicine, Centre Commons Building, 5750 Centre Avenue, Pittsburgh, PA 15206, USA.

Abstract

Objective.— To prospectively evaluate the diagnosis of menstrual migraine (MM) by comparing 2 diagnostic systems.

Methods.— Female migraineurs self-reporting a substantial relationship between migraine and menses were evaluated with 3 consecutive months of daily headache recording diaries. A relationship between menses and migraine was evaluated using International Classification of Headache Disorders (ICHD-II) criteria and a probability model called Probability MM.

Results.— Three months of pretreatment prospective diaries were completed by 126 women. ICHD-II menstrually related migraine was diagnosed in 73.8% with pure MM in 7.1%. ICHD-II and Probability diagnoses agreed for all cases of ICHD-II non-MM and pure MM, with disagreement among women diagnosed with ICHD-II menstrually related migraine, only half of whom were identified as having a relationship with menses greater than chance alone using the Probability model. Interestingly, 20% of those women self-reporting a substantial relationship between migraine and menses were not prospectively diagnosed with MM using either diagnostic system. Differences in menstrual vs nonmenstrual headaches were greater when using the Probability model.

Conclusions.— Prospective headache diaries are needed to diagnose MM. A probability-based method, which considers the chance occurrence of headaches during the menstrual cycle, identifies fewer women as having menstrually related migraine compared with the diary-based methods recommended by the current ICHD-II candidate criteria.

(Headache 2010;50:539-550)

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