Prevalence of migraine subtypes in women with endometriosis and/or dysmenorrhea: results from a cross-sectional multicenter trial

Migraine and endometriosis are both debilitating chronic pain conditions that frequently co-occur in women. We aimed to assess the prevalence of migraine in women with surgically confirmed endometriosis (SCE) compared to women without surgically confirmed endometriosis (non-SCE), and to explore the distribution of migraine subtypes in this population. In a cross-sectional multicenter study, 838 women were recruited from two endometriosis centers and a patient association. Participants completed a standardized online questionnaire assessing migraine phenotype (ICHD-3 criteria), endometriosis status (surgically confirmed or not), and current hormone therapy. Group comparisons were performed using statistical tests, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Surgically confirmed endometriosis (SCE) was present in 561 participants (67%), whereas 277 (33%) had no surgical confirmation (non-SCE). A total of 320 (38.2%) participants reported migraine. Migraine was more prevalent in women with SCE than in those without (41.0% vs. 32.5%; OR 1.44, 95% CI 1.07–1.95), and remained associated after adjustment for age, BMI, education, and hormonal therapy (adjusted OR 1.38, p = 0.048). Among those with migraine, 204 (63.8%) had non-menstrual migraine (NM), 93 (29.1%) had menstrually-related migraine (RM) and 23 (7.2%) had pure menstrual migraine (PM). Migraine with aura showed higher odds in the SCE group (OR 1.61, 95% CI 1.11–2.35), as did PM (OR 11.27, 95% CI 1.51–84.01). RM was associated with higher migraine frequency (p < 0.001), pain intensity (p = 0.019), and greater functional impairment (p < 0.001) than NM or PM. Participants with PM had lower rates of endocrine endometriosis/dysmenorrhea treatments (17.4% vs. 54.4% (NM) vs. 34.4% (RM); p < 0.001). Women with SCE show a higher prevalence of migraine – particularly migraine with aura and PM – than those without SCE. The observed co-occurrence of endometriosis and migraine highlights the need for increased clinical awareness and further prospective studies to explore implications for interdisciplinary management. However, no causality can be inferred from this cross-sectional study.