Endometriosis Features in Women With and Without Migraine

Abstract

Background: This study examines endometriosis (EM) features in women with EM and migraines (MG) (EM-MG) and women with EM alone (EM-O). The comorbidity of MG and EM is well known. However, knowledge about differences in symptoms, clinical manifestations, and severity of EM between EM-MG and EM-O is scarce. Materials and Methods: We conducted a cross-sectional observational study of premenopausal patients with biopsy-confirmed EM treated in our department from 2015 to 2021. All patients underwent surgical treatment for EM. Information about infiltration depth and localization of EM was available. We interviewed patients using a structured questionnaire that includes questions about clinical characteristics, symptoms, and treatment history. We reported categorical variables as frequencies and continuous variables as means with standard deviations. We compared subgroups (EM-MG vs. EM-O) using an independent sample t-test, the Wilcoxon-Mann-Whitney test, chi-square test, and Fisher's exact test. The significance level was 0.05. Results: We included 344 participants: 250 with EM-O and 94 with EM-MG. EM-MG had less severe revised American Society of Reproductive Medicine scores (p = 0.023), more deliveries (p = 0.009), more and higher scores of dysmenorrhea at menarche (p = 0.044; p = 0.036), prolonged heavy menstrual bleeding (p = 0.009), more and prolonged pain during menstrual bleeding (p = 0.011, p = 0.039), and more dyschezia (p < 0.001) compared with EM-O. Conclusion: Migraineurs experienced more intense EM symptoms at lower EM stages. This discrepancy strongly indicates pain sensitizations and a lower pain threshold in patients with EM-MG. Knowledge about EM features allows early diagnosis and treatment of women with potential EM-MG, both highly disabling conditions. Clinical Trials.gov (NCT04816357).

Keywords: ASRM; burden of disease; endometriosis; migraine.