title: Symptoms of premenstrual syndrome and their association with migraine headache.
abstract: OBJECTIVE
  To determine the association between the severity of premenstrual (PMS) symptoms and headache outcome measures during natural menstrual cycles and after medical oophorectomy.
  
  
  BACKGROUND
  Premenstrual syndrome may occur in 64% of those with pure menstrual migraine and 33% of those with menstrually related migraine. Few past studies have examined the relationship between the severity of PMS symptoms and migraine headache.
  
  
  METHODS
  Data were obtained from a 6.5-month randomized-controlled trial examining the role of medical oophorectomy in the prevention of migraine headache and later divided into two data sets for analysis purposes. The menstrual cycle data set was composed of data from three natural menstrual cycles obtained from 21 participants during lead-in and placebo run-in phases. Each menstrual cycle was subdivided into seven 3-day intervals based on urine hormone metabolites. The medical oophorectomy data set included data from a 2-month treatment period in which a medical oophorectomy was induced by gonadotropin-releasing hormone agonists (GnRHa) and participants were randomized to transdermal estradiol or a matching placebo (GnRHa/estradiol and GnRHa/placebo groups, respectively). All participants completed a daily diary recording the severity of PMS symptoms and headache outcome measures. The primary outcome measures were the PMS index (mean of the daily PMS severity scores) and the headache index (mean of the headache severity scores). Pearson correlation coefficients were used to assess the degree of association between the outcome measures.
  
  
  RESULTS
  Menstrual Cycle Data Set.-The PMS index was significantly correlated with the headache index during native menstrual cycles (correlation coefficient of 0.47; P < .05) and during all seven intervals of the menstrual cycle (correlation coefficients of 0.39 to 0.65; all P values < .05). Medical Oophorectomy Data Set.-Correlation coefficients between the PMS and headache indices were 0.58 and 0.47 for the GnRHa/estradiol (n = 9) and GnRHa/placebo groups, respectively (P-values of <.05).
  
  
  CONCLUSIONS
  Moderate correlations exist within female migraineurs between the severity of PMS symptoms and headache outcome measures throughout natural menstrual cycles as well as after medical oophorectomy. Our data would suggest that the presence and severity of headache might modulate PMS symptoms in female migraineurs.
authors.affiliation: Departmentof Internal Medicine, University of Cincinnati, Cincinnati, OH 45267-4217, USA.
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Martin
authors.forename: Suzanne
authors.initials: S
authors.lastname: Wernke
authors.forename: Karen
authors.initials: K
authors.lastname: Mandell
authors.forename: Nabih
authors.initials: N
authors.lastname: Ramadan
authors.forename: Lily
authors.initials: L
authors.lastname: Kao
authors.forename: Judy
authors.initials: J
authors.lastname: Bean
authors.forename: James
authors.initials: J
authors.lastname: Liu
authors.forename: Willie
authors.initials: W
authors.lastname: Zoma
authors.forename: Robert
authors.initials: R
authors.lastname: Rebar
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000652:urine; D006728:Hormones / Q000652:urine; D006801:Humans; D008881:Migraine Disorders / Q000150:complications* / Q000523:psychology; D010052:Ovariectomy; D011293:Premenstrual Syndrome / Q000150:complications* / Q000523:psychology
chemical_list: D006728:Hormones; D007987:Gonadotropin-Releasing Hormone