Woman at reproductive age suffering from migraines should consider getting evaluated for endometriosis.

The risk of endometriosis is significantly higher in women with migraine than in those without it.

Key Points

Highlights:

• A significant link between migraine and endometriosis was shown. Women with deep infiltrating endometriosis or ovarian endometrioma showed a stronger association.
• Women who suffer from migraines should be screened for endometriosis. This screening may assist with the early detection of endometriosis.

Importance:

• Deciphering the relationship between migraine and endometriosis may help to improve the delay in the diagnosis of endometriosis by screening women with migraines for endometriosis. Earlier diagnosis of endometriosis would optimize the care.

What’s done here?

• The occurrence of migraine was studied in 314 women with or without endometriosis.
• The risk of endometriosis in women with migraines was evaluated.

Key results:

• Migraine prevalence was significantly higher in women with endometriosis compared to those without.
• The risk of endometriosis, especially ovarian endometrioma and deep infiltrating endometriosis, was significantly higher in women with migraines.

Limitations of the study:

• Patients studied were from a referral center that specializes in endometriosis surgery and particularly sees patients with severe forms of the disease. This may have created a selection bias for the study.
• The number of patients in each sub-type of endometriosis might be too small to draw clear conclusions.

Lay Summary

What do migraine and endometriosis have in common? One can easily answer “pain”. Turns out there are other shared aspects when it comes to these two conditions: both have a high prevalence in women of childbearing age, both suffer from delayed diagnosis and treatment, and they generally have major socio-economic repercussions. They also show similarities in the underlying pathological mechanisms, which involve hormonal influence and chronic inflammation for both conditions.

There have been studies in the past showing a higher occurrence of migraines in women with endometriosis, and a higher prevalence of endometriosis in women with migraines. None of these studies, however, specifically assessed the risk of different endometriosis subtypes associated with migraine. A better understanding of these links could lead to better care of these patients, who suffer from recurrent pain.

The current study by Maitrot-Mantelet, published recently in the journal of Cephalalgia, aimed to determine the prevalence of migraine in women with endometriosis versus women without endometriosis; the risk of endometriosis in women with migraine compared to women without migraine; and the risk of endometriosis phenotypes associated with migraine.

314 women, 182 with endometriosis and 132 without, were studied. The results showed that 35% of women with endometriosis also suffered from migraines, while only 17% of women without endometriosis presented with migraines. The risk of endometriosis was shown to be significantly higher in women with migraines. When endometriosis phenotypes were compared, ovarian endometrioma and deep infiltrating endometriosis showed a higher risk in women with migraines.

The mechanism(s) underlying the link between migraine and endometriosis and the mechanism by which migraine might increase the risk of endometriosis is currently unknown. However, the authors offer a few possible explanations such as involvement of estradiol, since both conditions have peak prevalence between puberty and menopause; a key role for inflammation; shared genetic susceptibility for both conditions; and a disrupted ketone pathway as ketones are involved in pain signaling.

Regardless of the underlying mechanism(s), this study shows a significant association between migraine and endometriosis. The authors suggest that women of reproductive age who suffer from migraines should be screened for endometriosis criteria to improve the delay in the diagnosis of endometriosis and to optimize the medical and therapeutic care of this condition.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31810400