Do women with menstrual migraine have worse PMS and PMDD, and does coping strategy affect headache burden?

Background and objectives: Despite the considerable prevalence of premenstrual syndrome (PMS) in women with migraine, little attention has been given to the applied premenstrual coping strategies and their impact on headache severity, especially in menstrual migraine (MM). Therefore, this study aimed to investigate the severity of PMS, the Premenstrual Dysphoric Disorder (PMDD), the coping strategies used among women with MM versus those with non-MM, and to determine their impact on their perceived headache burden. Methods: In this cross-sectional study, existing diary data covering at least three consecutive menstrual cycles were reviewed to classify participants as having MM or non-MM. All patients were evaluated by the Headache Impact Test-6 (HIT-6), Premenstrual Symptoms Screening Tool (PSST) and the Premenstrual Coping Measure. Results: This study was conducted on 445 females with MM and 156 with non-MM. Females with MM had significantly higher PSST and HIT-6 scores ( p = 0.001, 0.002, respectively) than the non-MM group. The diagnosis of PMDD was confirmed in 5.6 and 1.9% of females with and without MM, respectively ( p = 0.06). By linear regression analysis, the presence of PMDD was associated with an increase of 3.113 points in HIT-6 scores (95%CI: 0.607-5.915, p = 0.016). In addition, higher PSST scores and lower awareness and acceptance scores were significantly associated with higher HIT-6 scores ( p ≤ 0.001 for both). Conclusion: Women with a confirmed diagnosis of PMDD, high PMS symptom severity and lower frequency of using the awareness and acceptance coping strategy are at risk of increased headache burden.

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