title: Development of a simple menstrual migraine screening tool for obstetric and gynecology clinics: the menstrual migraine assessment tool.
abstract: OBJECTIVE
  To develop and validate a brief questionnaire to screen for menstrual migraine (MM), and to estimate MM prevalence in an obstetrics and gynecology (OB/GYN) setting in a pilot study.
  
  
  METHODS
  Patients with unknown MM status from a headache clinic completed a 9-item questionnaire. The attributes of each question were compared with a validated headache calendar to develop a 3-item MM questionnaire. The headache calendar and questionnaire were then administered to nonpregnant/nonmenopausal OB/GYN patients. A diagnosis was assigned by a blinded specialist using the headache calendar, and MM prevalence was determined.
  
  
  RESULTS
  The analysis yielded 3 relevant questions administered to 250 women for our tool, called the Menstrual Migraine Assessment Tool (MMAT): (1) "Do you have headaches that are related to your period (ie, occur between 2 days before the onset of your period, until the third day of your period) most months?" (2) "When my headaches are related to my period, they eventually become severe"; (3) "When my headaches are related to my period, light bothers me more than when I don't have a headache." If question 1 was positive, questions 2 and 3 were answered. Among women responding positively to question 1 and > or =1 other question, the sensitivity and specificity were 0.94 and 0.74, respectively. Of 610 randomly chosen OB/GYN patients, 12.1% had pure MM (ie, migraine exclusively between days +2 and -3 of menses), 10.1% had menstrually related migraine (ie, MM and attacks at other times), and 14.1% had migraine without relation to their menses.
  
  
  CONCLUSIONS
  The MM screener MMAT exhibits sufficient sensitivity and specificity to assess this frequently disabling condition presenting at the OB/GYN office.
authors.affiliation: Center for Headache and Pain, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Tepper
authors.forename: Mary
authors.initials: M
authors.lastname: Zatochill
authors.forename: Marjorie
authors.initials: M
authors.lastname: Szeto
authors.forename: Fred
authors.initials: F
authors.lastname: Sheftell
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Tepper
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bigal
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000639:trends; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008597:Menstrual Cycle / Q000502:physiology; D008599:Menstruation Disturbances / Q000453:epidemiology*; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D009775:Obstetrics and Gynecology Department, Hospital / Q000639:trends; D011237:Predictive Value of Tests; D011293:Premenstrual Syndrome / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards; D055815:Young Adult