| Part Ⅰ:Clinical Differences Between Menstrual Migraine and non-Menstrual Migraine: a Systematic Review and Meta-analysis of Observational StudiesObjective(s): Approximately 60% of female migraineurs experience menstrual migraine(MM).Whether MM is a distinct clinical entity with more severe migraine attacks and a worse prognosis than non-menstrual migraine(n MM)is still under debate.We conducted a systematic review and meta-analysis to investigate clinical differences between MM and n MM patients.Methods: A systematic literature search was performed to identify observational studies comparing MM and n MM patients’ clinical characteristics.Quality of evidence grades of the synthesized effect estimates for each outcome were determined following the Grading of Recommendations Assessment,Development and Evaluation(GRADE)guidelines.Results: Of 1837 identified studies,16 were eligible for inclusion.MM patients had more migraine attacks per month(MD 0.65,95% CI 0.05–1.24)than n MM patients;however,the quality of evidence was “low” according to the GRADE assessment.They also had more headache days(MD 0.86,95% CI 0.12–1.60)per month,a higher rate of family history of migraine(OR 1.41 95% CI 1.12–1.78),migraine aggravation with physical activity(OR 1.60,95% CI 1.35–1.89),a younger age at migraine onset(MD-0.99,95% CI-1.78 to-0.19),and a higher risk of accompanying symptoms(OR 2.31,95% CI 1.72–3.10)than n MM patients;however,the quality of evidence was “very low”.Conclusion(s): There were differences between MM and n MM,showing that MM patients have a worse profile than n MM patients,but the quality of evidence is too low to draw definite conclusions on the separation/unification of the two clinical entities.Part Ⅱ: Sources of Differences in Clinical Features Between Menstrual and non-Menstrual Migraine: A Prospective Cohort Registry StudyObjective(s): To determine the clinical differences and prognosis variation between menstrual migraine(MM)and nonmenstrual migraine(n MM).Methods: Female patients with migraine fulfill the International Classification of Headache(ICHD)diagnostic criterial were prospectively registered from September 2018 to June 2022,and then classified into PMM,MRM and n MM groups.The clinical characteristics of migraine(migraine frequency [day/month],headache severity [VAS],attack duration [hour/time],accompanying symptoms [nausea,vomiting,photophobia,and phonophobia],frequency of painkiller use [day/month],quality of life [assessed using Migraine-Specific Quality of Life Questionnaire,MSQo L and Migraine Disability Assessment Scale,MIDAS]and psychological status(assessed using the Hospital Anxiety and Depression Scale,HADS)of all included patients were evaluated at the time of enrollment,3-month,and 6-months follow-ups.Analyses of variance,non-parametric test and chi-square test were used to compare different types of variables among the three groups.LSD-t test,Wilcoxon rank sum test and chi-square test were used for pairwise comparisons when the results were statistically different.A p-value <0.05 was considered statistically significant.Results: At enrollment,VAS scores in the PMM group were higher than those in the n MM and MRM groups(7.12±1.01 vs.6.11±1.49,P=0.001),(7.12±1.01 vs.6.31±1.44,P=0.008).The duration of migraine in PMM and MRM groups was higher than that in n MM group(12.80±3.67 vs.10.49±3.71,P=0.003),(11.93±3.18 vs.10.49±3.71,P=0.001).The PMM group had high proportion of accompanying symptoms [nausea(84.0% vs.61.0%,P=0.027),vomiting(64.0% vs.41.2%,P=0.035),and photophobia(84.0% vs.62.5%,P=0.037)] than the n MM group.The MSQo L score of MRM group was lower than that of n MM and PMM groups(59.17±13.41 vs.62.54±10.67,P=0.013),(59.17±13.41 vs.64.00±8.48,P=0.036).The HADS score of MRM group was higher than that of n MM and PMM group(HADS-A)(8.46±2.74 vs.6.91±1.38,P<0.001),(8.46±2.74 vs.6.88±2.17,P<0.014),Depression scale(HADS-D)(6.70±2.27 vs.4.74 ± 1.73,P < 0.001),(6.70±2.27 vs.5.24 ±1.98,P=0.004)).At 3-months of follow-up,the monthly frequency of migraine was higher in the MRM group than in the n MM and PMM groups(5.13±3.45 vs.3.40±1.79,P<0.001),(5.13±3.45 vs.2.76±0.93,P<0.001),monthly pain medication use was more frequent than in the n MM and PMM groups(4.10±2.84 vs.2.88±2.02,P=0.001),(4.10±2.84 vs.2.56±0.92,P=0.006);MSQo L score was lower than in the n MM and PMM groups(57.99±12.62 vs.61.66±10.91,P=0.011),(57.99±12.62 vs.66.00±8.86,P=0.002),The HADS score was higher than in the n MM and PMM groups(HADS-A(8.97±2.74 vs.7.21±1.47,P<0.001),(8.97±2.74 vs.7.36±1.44,P=0.005)and HADS-D(7.10±1.91 vs.5.23±1.82,P<0.001),(7.10±1.91 vs.5.68±1.70,P=0.001).The VAS score of PMM and MRM patients was higher than that of n MM group(7.16±0.94 vs.6.21±1.54,P=0.002),(6.77±1.46 vs.6.21±1.54,P=0.002).At 6-months of follow-up,migraine attacks were more frequent in MRM group than in n MM and PMM groups(5.73±3.17 vs.4.65±3.22,P<0.001),(5.73±3.17 vs.3.12±0.94,P<0.001);monthly use of painkillers was more frequent than in n MM and PMM groups(4.24±2.78 vs.3.79±2.96,P=0.063),(4.24±2.78 vs.2.52±1.12,P=0.001);the MSQo L score was lower than in n MM and PMM groups(55.83±9.04 vs.60.43±10.42,P<0.011),(55.83±9.04 vs.60.12±6.00,P=0.012)and HADS-D scores were higher than in n MM and PMM groups(7.56±2.16 vs.6.00±2.52,P<0.001),(7.56±2.16 vs.5.80±1.68,P=0.004).Accompanying symptoms were more frequently seen in PMM group than in n MM and PMM group [nausea(88.0% vs.61.8%,P=0.011),(88.0% vs.67.5%,P=0.039),vomiting(72.0% vs.38.2%,P=0.002),(72.0% vs.49.2%,P=0.037).Conclusion(s): The differences in clinical characteristics between MM and n MM were mainly attributed to the variances between MRM and n MM,such as monthly migraine attack frequency,monthly analgesic use frequency,quality of life,and psychological status.Patients with PMM were more prominent in terms of accompanying symptoms and headache pain severity.In summary,the prognosis of MRM was poorer than other types migraine.The necessary to distinguish between PMM and MRM in clinic needs further investigation. |
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