Clinical characteristics and social burden of menstrual migraine in Japan: an online-based cross-sectional questionnaire study

Abstract

Background: Menstrual migraine (MM) is a distinct and burdensome subtype of migraine; however, comprehensive data on its clinical and social impact among Japanese females remain limited. Therefore, we aimed to clarify the clinical characteristics and social burden of MM in Japan.

Methods: A cross-sectional, population-based web survey was conducted among Japanese females (≥ 18 years) with regular menstruation who were diagnosed with migraine. Participants were classified into MM and non-MM groups. Clinical parameters assessed between MM and non-MM included pain intensity, pain duration, and headache frequency during the perimenstrual period (-2 days to + 2 days of menstruation onset). Social burden was evaluated using the Migraine Disability Assessment (MIDAS), Migraine Interictal Burden Scale (MIBS-4), Migraine-Specific Quality of Life Questionnaire (MSQ), and Work Productivity and Activity Impairment for Migraine (WPAI-M). These were compared between MM and non-MM, adjusting for potential confounders through inverse probability of treatment weighting using propensity scores.

Results: Of 266,392 screened patients, 4,592 were included in MM and 5,174 in non-MM. The mean age was 36.8 ± 8.0 years in MM and 35.5 ± 8.3 years in non-MM. MM patients experienced higher pain intensity and longer pain duration than non-MM during both perimenstrual and non-perimenstrual periods (perimenstrual periods: -2 days to + 1 day of menstruation onset: all p < 0.001 for both, +2 days of menstruation onset: intensity, p = 0.003, duration, p = 0.046; non-perimenstrual period: intensity, p < 0.001, duration, p = 0.005). MM exhibited higher MIDAS and MIBS-4 scores (both p < 0.001) and lower MSQ scores (restriction, interference, emotion: all p < 0.001), indicating greater disability and reduced quality of life. Among WPAI-M scores, presenteeism, overall work and activity impairment, were also higher in MM vs non-MM (all p < 0.001). MM demonstrated increased usage (MM: 54.0% [1,088/2,015]; non-MM: 24.0% [169/705]) and broader type of medications (MM: 13.2% [265/2,015]; non-MM: 7.1% [50/705]) during the perimenstrual period, particularly non-steroidal anti-inflammatory drugs (MM: 51.4% [801/1,557]; non-MM: 45.4% [636/1,402]).

Conclusions: This study highlights the significant burden of MM, demonstrating increased pain intensity, longer pain duration and higher headache frequency during perimenstrual period, accompanied by a concurrent increase in social burden compared to non-MM. These findings underscore the impact of clinical severity and social burden of MM in Japanese females.

Keywords: Cross-sectional study; Menstrual migraine; Menstrually related migraine; Real-world evidence; Social burden.

Fig. 1

Patient disposition and group creation. ICHD-3, International Classification of Headache Disorders, 3rd edition; MM, menstrual migraine; MRM, menstrually-related migraine; PMM, pure menstrual migraine

Fig. 2

(A) Pain intensity and (B) headache frequency during menstrual periods in the non-MM and MM groups. Error bars represent standard deviation. The difference (95% CI) and p-value are presented for the outcome of the comparison between MM and non-MM groups following IPTW adjustment. CI, confidence interval; IPTW, inverse probability of treatment weighting; MM, menstrual migraine; VAS, Visual Analog Scale

Fig. 3

Burden of MM (A) MIBS-4 and MIDAS scores (B) MSQ score and (C) WPAI-M score. Error bars represent standard deviation. The difference (95% CI) and p-value are presented for the outcome of the comparison between MM and non-MM groups following IPTW adjustment. CI, confidence interval; IPTW, inverse probability of treatment weighting; MIBS-4, Migraine Interictal Burden Scale; MIDAS, Migraine Disability Assessment; MM, menstrual migraine; MSQ, Migraine-Specific Quality-of-Life Questionnaire version 2.1; WPAI M, Work Productivity and Activity Impairment for Migraine.