Development of a simple menstrual migraine screening tool for obstetric and gynecology clinics: the menstrual migraine assessment tool

Abstract

Objective: To develop and validate a brief questionnaire to screen for menstrual migraine (MM), and to estimate MM prevalence in an obstetrics and gynecology (OB/GYN) setting in a pilot study.

Methods: Patients with unknown MM status from a headache clinic completed a 9-item questionnaire. The attributes of each question were compared with a validated headache calendar to develop a 3-item MM questionnaire. The headache calendar and questionnaire were then administered to nonpregnant/nonmenopausal OB/GYN patients. A diagnosis was assigned by a blinded specialist using the headache calendar, and MM prevalence was determined.

Results: The analysis yielded 3 relevant questions administered to 250 women for our tool, called the Menstrual Migraine Assessment Tool (MMAT): (1) "Do you have headaches that are related to your period (ie, occur between 2 days before the onset of your period, until the third day of your period) most months?" (2) "When my headaches are related to my period, they eventually become severe"; (3) "When my headaches are related to my period, light bothers me more than when I don't have a headache." If question 1 was positive, questions 2 and 3 were answered. Among women responding positively to question 1 and > or =1 other question, the sensitivity and specificity were 0.94 and 0.74, respectively. Of 610 randomly chosen OB/GYN patients, 12.1% had pure MM (ie, migraine exclusively between days +2 and -3 of menses), 10.1% had menstrually related migraine (ie, MM and attacks at other times), and 14.1% had migraine without relation to their menses.

Conclusion: The MM screener MMAT exhibits sufficient sensitivity and specificity to assess this frequently disabling condition presenting at the OB/GYN office.