Perimenstrual migraines: are they different from migraines in general?

Differences between menstrually related migraine (MRM) and non-MRM are subtle. Preconception that population-based trials do not show differences, but that clinic-based trials showed severe, longer, and clinically refractory menstrual migraines, turns out to be simplistic. This review examines studies comparing and contrasting MRM and non-MRM. All of the pertinent studies show increase of migraine around menses. A judicious reading of the studies suggests that MRM is probably more severe in pain intensity than non-MRM. MRM is more disabling than non-MRM. MRM in clinics is more likely to have both worse prodrome and nausea. A significant subset of MRM patients has poorer response to acute medication. Overall, it appears that MRM is more severe than non-MRM when considering population- and clinic-based studies, with slightly but clinically meaningfully worse intensity, duration, disability, prodrome, nausea, and response to acute medications. Clinicians must have compassion and skill to manage patients with MRM.