Characterizing a Population Reporting Menstrually Related Migraine: Multi-country Results from the Chronic Migraine Epidemiology and Outcomes–international (CaMEO-I) Study
Jessica Ailani1, Jelena Pavlovic2, Deena Kuruvilla3, Nicole Naccara4, Kristina Fanning5, Janette Contreras-De Lama4, Dawn Buse2
1Medstar Georgetown Neurology, 2Albert Einstein College of Medicine, 3Brain Health Institute, 4AbbVie, 5MIST Reserach
Objective:
To characterize a population reporting menstrual migraine (MM) in CaMEO-I study respondents from the United States (US), Canada, France, Germany, the United Kingdom (UK), and Japan.
Background:
MM is defined as migraine attacks occurring in the perimenstrual window. MM attacks can be longer‑lasting, more severe, and less responsive to treatment compared with non-menstrual migraine attacks.
Design/Methods:
CaMEO-I was a cross-sectional, web-based survey conducted in 2021-2022. Among all CaMEO-I respondents from multiple countries, this analysis included adult females (age: 18 to 50 years) meeting International Classification of Headache Disorders, 3rd edition (ICHD-3) migraine criteria; those who were postmenopausal or pregnant were excluded. Participants self-reported migraine or “severe headaches” occurring around the onset of menstruation. Acute treatment optimization was evaluated with the 4-item Migraine Treatment Optimization Questionnaire (mTOQ-4). The sum of the items was used to categorize treatment optimization as very poor (0), poor (1–5), moderate (6–7), or maximum (8). Group differences in treatment optimization were examined across the mTOQ categories using chi-square tests.
Results:
Of 14,492 CaMEO-I respondents, 6,395 (44.1%) met eligibility criteria. Of these, 5.1% (327/6395) reported all migraine attacks, and 61.0% (3901/6395) reported at least some attacks around menstruation. Among eligible respondents, the mean (SD) age was 33.4 (8.8) years, 7.2% (462/6395) had chronic migraine, and 21.9% (1402/6395) were obese. Menstrually related headaches/migraine diagnosis was reported in 14.8% (947/6395) of respondents, either by self-report or clinician diagnosis. Across countries, the majority of women had poor treatment optimization [mTOQ very poor: 8.1% (474/5832), poor: 53.8% (3139/5832), moderate: 22.3% (1299/5832), and maximum: 15.8% (920/5832); P<.001].
Conclusions:
Across multiple countries, MM was common and associated with poor acute treatment optimization, underscoring a substantial unmet need in effective management. These findings highlight opportunities to improve care strategies for women affected by MM worldwide.
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