- Attacks, in a menstruating woman1, fulfilling criteria for 1.2 Migraine with aura and criterion B below
- Not fulfilling criterion B for A220.127.116.11 Pure menstrual migraine with aura or A18.104.22.168 Menstrually-related migraine with aura.
For the purposes of ICHD-3, menstruation is considered to be endometrial bleeding resulting from either the normal menstrual cycle or from the withdrawal of exogenous progestogens, as in the use of combined oral contraceptives or cyclical hormone replacement therapy.
This subclassification of 1.2 Migraine with aura is clearly applicable only to menstruating women as defined above.
Menstrual attacks of migraine are mostly without aura. These criteria for A22.214.171.124 Pure menstrual migraine with aura and A126.96.36.199 Menstrually-related migraine with aura are included to allow these uncommon subforms to be better characterized. Criteria for A188.8.131.52 Non-menstrual migraine with aura are included for completeness.
Many women over-report an association between attacks and menstruation; for research purposes, diary-documented, prospectively-recorded evidence over a minimum of three cycles is necessary to confirm the diagnosis.
The mechanism(s) of migraine may be different with endometrial bleeding resulting from the normal menstrual cycle and bleeding due to the withdrawal of exogenous progestogens (as occurs with combined oral contraception and cyclical hormone replacement therapy). For example, the endogenous menstrual cycle results from complex hormonal changes in the hypothalamic-pituitary-ovarian axis resulting in ovulation, which is suppressed by use of combined oral contraceptives. Therefore research should separate these distinct subpopulations even though the diagnostic criteria do not.