Migraine among women with endometriosis: a hospital-based case-control study in Bangladesh

Abstract

BackgroundEndometriosis is a disease among women of reproductive age, which causes several health problems like dysmenorrhoea, dyspareunia and subfertility. It also increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of population completely different from Bangladesh. ObjectiveThe present study was conducted to identify the association between endometriosis and migraine among Bangladeshi population. Study DesignThis non-randomized case-control study was performed with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, we identified as cases of migraine in one group of respondents who were already diagnosed as patients of migraine and the others with complaints of headache were further confirmed by a medicine specialist. Patients were recruited from the department of obstetrics and gynaecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital & Ibrahim Medical College. The study was approved by the Ethical Review Committee of BIRDEM. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals. ResultsIn our study, out of the 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. We enrolled 190 confirmed endometriosis cases and an equal number of controls without endometriosis, maintaining the age distribution of the controls similar to that of the cases. The distribution of age, BMI, education and marital status of the patients with endometriosis were similar to that of controls. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than in controls (12% vs 0%). The odds of suffering from dysmenorrhoea and dyspareunia among the cases were 3.3 (P value <0.001, 95% CI: 2.66-4.15) and 9.5 (P value <0.001, 95% CI: 5.3-17.9) times higher than that of controls respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases compared to that of controls (OR = 0.4, P value <0.001 95% CI: 0.24-0.64). No significant difference was observed in having primary subfertility and secondary subfertility among the two groups of respondents. Univariate regression analysis showed patients with endometriosis have 6.13 times higher odds (P value <0.001, 95% CI: 2.5-18.4) of having migraine, 2-time higher odds for headache (P value = 0.01, 95% CI: 1.2-3.2) compared to control patients. Further, the age and BMI-adjusted multivariate model showed subjects with endometriosis have 5.4 times higher odds of having migraine compared to non-endometriosis patients (P value <0.001, 95% CI: 2.11-16.4). Also, the higher the age of reproductive age of women, the more the odds of having migraine. For one year increase in age increases the odds of having migraine by 23% (OR = 1.23. 95% CI: 1.13-1.16, p-value = <0.001). ConclusionThe study results support the association between endometriosis and migraine among the Bangladeshi population, which is similar to relevant studies conducted in other geographical locations. The groups of physicians who treat patients suffering from the two diseases, endometriosis and migraine, should keep this interrelationship in mind to ensure a better quality of a patient's life.