Identifying menstrual migraine\u2013 improving the diagnostic criteria using a statistical method

Mathias Barra,Fredrik A Dahl,Kjersti Grøtta Vetvik,E Anne Macgregor

doi:10.1186/s10194-019-1035-7

Abstract

ObjectiveTo develop a robust statistical tool for the diagnosis of menstrually related migraine.BackgroundThe International Classification of Headache Disorders (ICHD) has diagnostic criteria for menstrual migraine within the appendix. These include the requirement for menstrual attacks to occur within a 5-day window in at least frac {2}{3} menstrual cycles (frac {2}{3}-criterion). While this criterion has been shown to be sensitive, it is not specific. Yet in some circumstances, for example to establish the underlying pathophysiology of menstrual attacks, specificity is also important, to ensure that only women in whom the relationship between migraine and menstruation is more than a chance occurrence are recruited.MethodsUsing a simple mathematical model, a Markov chain, to model migraine attacks we developed a statistical criterion to diagnose menstrual migraine (sMM). We then analysed a data set of migraine diaries using both the frac {2}{3}-criterion and the sMM.ResultssMM was superior to the frac {2}{3}-criterion for varying numbers of menstrual cycles and increased in accuracy with more cycle data. In contrast, the frac {2}{3}-criterion showed maximum sensitivity only for three cycles, although specificity increased with more cycle data.ConclusionsWhile the ICHD frac {2}{3}-criterion is a simple screening tool for menstrual migraine, the sMM provides a more specific diagnosis and can be applied irrespective of the number of menstrual cycles recorded. It is particularly useful for clinical trials of menstrual migraine where a chance association between migraine and menstruation must be excluded.

Highlights

The criteria are based on three main features: Menstrual migraineThe International Classification of Headache Disorders 3 (ICHD3) provides diagnostic criteria for menstrual migraine without aura (MM)1[1]
Provides a more specific diagnosis and can be applied irrespective of the number of menstrual cycles recorded. It is useful for clinical trials of menstrual migraine where a chance association between migraine and menstruation must be excluded
Removing the need for non-clustering – trimming: counting only attack-starts Returning to the Markov chain model, we realize that it can be appropriate to perform the test just discussed if we focus solely on days of the headache diary which corresponds to the transition probability μ

Summary

Introduction

The International Classification of Headache Disorders 3 (ICHD3) provides diagnostic criteria for menstrual migraine without aura (MM)1[1]. As these criteria have not been thoroughly validated they are placed in the appendix. The timing of attacks in relation to menstruation: they should occur during the menstrual window, i.e. the 5-days starting two days before onset of menstruation until the third day of bleeding (i.e. day 1 ± 2); and Lørenskog, Norway 2C3 – Centre for Connected Care, Oslo University Hospital, Oslo, Norway. The International Classification of Headache Disorders (ICHD) has diagnostic criteria for menstrual migraine within the appendix. These include the requirement for menstrual attacks to occur within a 5-day window in at least. For example to establish the underlying pathophysiology of menstrual attacks, specificity is important, to ensure that only women in whom the relationship between migraine and menstruation is more than a chance occurrence are recruited

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Discussion

Conclusion