Menstrual migraine can be a tricky diagnosis. Test your knowledge of the headaches and gather clinical tips with our 8-question quiz.
Menstrual Migraine: A Test plus Tips for Primary Care. Menstrual migraine is very common among women of reproductive age but is not always a straightforward diagnosis. Find out how much you know about the menace of menses with this 8-question quiz and take home some tips along the way.
Question 1: A 25-year-old woman presents with headaches in association with menses that don't respond to OTC pain relievers and can last up to 72 hours if not treated. What is the most likely diagnosis for her headache?
Answer: C. Migraine headache. The most likely diagnosis is migraine given the association with menses, duration of the attacks, the cognitive dysfunction, and the lack of efficacy of OTC NSAIDs.
Answer: D. ~60%. About 60% of women with migraine have menstrual migraine, which is equivalent to >10 million women with menstrual migraine in any given year in the US.
Answer: B. Nausea. Epidemiologic studies show that 73% of migraineurs experience nausea with some of their migraine attacks.
Answer: D. In association with at least 66% of menses. The ICHD states that to make the diagnosis of menstrual migraine, a migraine attack must occur with at least 66% of a woman's menstrual cycle. Also, this migraine must occur within -2 to +3 of a woman's cycle.
Answer: B. False. Menstrual-related migraine is more common than pure menstrual migraine with the latter occurring exclusively with menses. This distinction is important as the treatment approaches are different.
Question 6: For an otherwise healthy woman aged 25 years who is a non-smoker and whose only Rx is combined ethinyl estradiol/ progestin contraceptive pill, what would be a reasonable first-line treatment option for her migraine attacks?
Answer: B. Sumatriptan 100 mg. Triptans are migraine-specific and typically more effective than OTC or Rx-strength NSAID.
Question 7: Herbal preparations that show some efficacy for migraine prevention include all of those listed above except which one?
Answer: D. Vitamin D. Vitamin D has not been shown effective for migraine prevention while efficacy for B2, butterbur, magnesium, and CoQ10 for prevention of migraine has been demonstrated in clinical trials. The strongest level of evidence is for butterbur, which is now listed as Category A evidence in published guidelines for migraine prevention.5
Question 8: Which of the above would not be an additional treatment option for the same healthy 25-year-old woman?
References:Â 1.Â Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30:1065-1072.2.Â Mannix LK, Calhoun AH. Menstrual migraine. Curr Treat Options Neurol. 2004;6:489-498.3.Â Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: Data from the American migraine study II. Headache. 2001;41:646-657.4.Â International Headache Society. The international classification of headache disorders 3rd edition (beta version). Cephalalgia. 2013;33:629-808.5.Â Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatment for episodic migraine in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1346-1353.Â