title: Disability associated with headaches occurring inside and outside the menstrual period in those with migraine: a general practice study.
abstract: OBJECTIVE
  This study investigated the disability of females who have migraine and other headache attacks occurring during and outside the menstrual period.
  
  
  METHODS
  One thousand four hundred and thirty-four of 3470 female patients (41.3%) aged 14 to 50 years registered at a UK general practice completed two questionnaires. The first questionnaire assessed the prevalence of headache, depression, and bodily pain in the total population. The second questionnaire assessed the disability of all headaches over a 2-month period (to capture a complete menstrual cycle) for patients reporting migraine who were still menstruating. Disability was assessed as the time lost and time spent at less than 50% productivity in normal activities due to headache, and analyzed as rank sums using the Mann-Whitney U-test.
  
  
  RESULTS
  The first part of the study showed that the prevalence of headache (66.1%), depression (55.4%), and bodily pain (40.6%) were high in this population of women. Thirty migraine patients who were still menstruating reported 89 migraine and 114 nonmigraine headache episodes in the second part of the study. For migraine, the rank order of time at less than 50% productivity was greater for attacks taking place inside the menstrual period than for those occurring outside the menstrual period. The comparison was significant for time at less than 50% productivity (P=.01). For nonmigraine headaches, the rank order of time lost was greater for attacks taking place outside the menstrual period than for those occurring inside the menstrual period. The comparison was not significant for time lost (P= .06).
  
  
  CONCLUSIONS
  For those with migraine, migraine attacks that took place during the menstrual period tended to be slightly more disabling than those taking place outside the menstrual period, but the opposite was true for nonmigraine headache.
authors.affiliation: King's Headache Service, King's College Hospital, London, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Dowson
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Kilminster
authors.forename: Rebecca
authors.initials: R
authors.lastname: Salt
authors.forename: Matthew
authors.initials: M
authors.lastname: Clark
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bundy
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression; D006233:Persons with Disabilities / Q000145:classification*; D005194:Family Practice; D005260:Female; D020773:Headache Disorders / Q000145:classification* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008597:Menstrual Cycle; D008875:Middle Aged; D008881:Migraine Disorders / Q000145:classification* / Q000503:physiopathology / Q000523:psychology; D010146:Pain; D011795:Surveys and Questionnaires; D006113:United Kingdom