The Indian Journal of Pediatrics

, Volume 86, Supplement 1, pp 25–33 | Cite as

Menstrual Cycle and Headache in Teenagers

  • Luigi Bianchin
  • Mauro Bozzola
  • Antonio Battistella Pier
  • Sergio Bernasconi
  • Gianni Bona
  • Fabio Buzi
  • Carlo De Sanctis
  • Vincenzo De Sanctis
  • Giorgio Tonini
  • Giorgio Radetti
  • Franco Rigon
  • Egle PerissinottoEmail author
Review Article



This population-based study on school-aged girls aimed to estimate the rate of peri-menstrual headache, evaluate headache pain pattern during the menstrual cycle, and verify its relationships with physical, psychosocial and life-style factors.


The students (n = 4973) fulfilled a self-administered questionnaire on demographic and behavioral characteristics, menarche, menstrual pattern and features including headache and dysmenorrhea. The prevalence of headache and the mean pain intensity score at the three menstrual cycle phases (premenstrual, menstrual, in-between period) were estimated, both overall and by gynecological year. Furthermore, the prevalence of three different patterns of headache (peri menstrual/mid-cycle/acyclic) was evaluated, together with the mean pain intensity score.


The overall prevalence of headache at least once at any time during the menstrual cycle was 64.4%. At multivariable logistic analysis, gynecological age (OR 1.07; 95%CI 1.03–1.12), middle social level (1.24; 1.01–1.55, compared to high social level), physical activity (0.67; 0.51–0.89), oral contraceptive use (1.34; 1.04–1.73) and dysmenorrhea (2.30; 1.54–3.42) were significantly associated with headache. Among girls with headache, 83.4% had peri-menstrual headache (44.6% premenstrual, 38.8% menstrual), 3.5% mid-cycle headache and 13.2% acyclic headache. The gynaecological age and dysmenorrhea were significantly associated with the headache pattern (p = 0.03 and p < 0.0001, respectively).


This study suggests that peri-menstrual headache is highly prevalent among adolescents. In girls, the headache rate linearly raises with higher gynecological age; menses-related painful syndromes, such as headache and dysmenorrhea, are strongly interrelated. The anamnesis and monitoring of menstrual health should be mandatory when taking care of girls with headache.


Adolescents. Menstrual headache Headache pattern Pain Gynecological age Dysmenorrhea 



DSC: Conception and design of the study, acquisition of data, revision of the paper; DSV: Conception and design of the study, acquisition of data, interpretation of data, revision of the paper; PE: Conception of the scientific question and design of the study, analysis and interpretation of data, draft and revision of the paper; RG: Conception and design of the study, acquisition of data, interpretation of data, revision of the paper; RF: conception and design of the study, acquisition of data, interpretation of data, revision of the paper.

BL: Conception of the scientific question and design of the study, analysis and interpretation of data, draft and revision of the paper; BM: Conception and design of the study, acquisition of data, interpretation of data, revision of the paper; BPA: Conception of the scientific question, revision of the paper; BS, BG, BF and TG: Conception and design of the study, acquisition of data, interpretation of data and revision of the paper. PE will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest


Source of Funding



  1. 1.
    Buse DC, Loder EW, Gorman JA, et al. Sex differences in the prevalence, symptoms, and associated features of migraine, probable migraine and other severe headache: results of the American migraine prevalence and prevention (AMPP) study. Headache. 2013;53:1278–99.Google Scholar
  2. 2.
    Macgregor EA, Rosenberg JD, Kurth T. Sex-related differences in epidemiological and clinic-based headache studies. Headache. 2011;51:843–59.CrossRefPubMedGoogle Scholar
  3. 3.
    Amandusson Å, Blomqvist A. Estrogenic influences in pain processing. Front Neuroendocrinol. 2013;34:329–49.CrossRefPubMedGoogle Scholar
  4. 4.
    Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.CrossRefGoogle Scholar
  5. 5.
    Crawford MJ, Lehman L, Slater S, et al. Menstrual migraine in adolescents. Headache. 2009;49:341–7.Google Scholar
  6. 6.
    Kröner-Herwig B, Vath N. Menarche in girls and headache--a longitudinal analysis. Headache. 2009;49:860–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Aegidius KL, Zwart J-A, Hagen K, Dyb G, Holmen TL, Stovner LJ. Increased headache prevalence in female adolescents and adult women with early menarche. The head-HUNT studies. Eur J Neurol. 2011;18:321–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Hershey AD. Menstrual migraine: how early can it start? Headache. 2009;49:348–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents: a review. Pain. 1991;46:247–64.CrossRefPubMedGoogle Scholar
  10. 10.
    Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, et al. Pain in children and adolescents: a common experience. Pain. 2000;87:51–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Bellini B, Arruda M, Cescut A, et al. Headache and comorbidity in children and adolescents. J Headache Pain. 2013;14:79.Google Scholar
  12. 12.
    Rhee H. Relationships between physical symptoms and pubertal development. J Pediatr Health Care. 2005;19:95–103.PubMedGoogle Scholar
  13. 13.
    Lateef TM, Merikangas KR, He J, et al. Headache in a national sample of american children: prevalence and comorbidity. J Child Neurol. 2009;24:536–43.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Zwart J-A, Dyb G, Holmen TL, Stovner LJ, Sand T. The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trøndelag health study (head-HUNT-youth), a large population-based epidemiological study. Cephalalgia. 2004;24:373–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Wöber-Bingöl C. Epidemiology of migraine and headache in children and adolescents. Curr Pain Headache Rep. 2013;17:341.CrossRefPubMedGoogle Scholar
  16. 16.
    Lewis DW, Gozzo YF, Avner MT. The “other” primary headaches in children and adolescents. Pediatr Neurol. 2005;33:303–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Sillanpää M, Aro H. Headache in teenagers: comorbidity and prognosis. Funct Neurol. 2000;15:116–21.PubMedGoogle Scholar
  18. 18.
    LeResche L, Mancl LA, Drangsholt MT, Saunders K, Von Korff M. Relationship of pain and symptoms to pubertal development in adolescents. Pain. 2005;118:201–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30:1065–72.CrossRefPubMedGoogle Scholar
  20. 20.
    Marcus DA. Estrogen and tension-type headache. Curr Pain Headache Rep. 2001;5:449–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis--part 2. Headache. 2006;46:365–86.CrossRefPubMedGoogle Scholar
  22. 22.
    Rigon F, Bianchin L, Bernasconi S, et al. Update on age at menarche in Italy: toward the leveling off of the secular trend. J Adolesc Health. 2010;46:238–44.Google Scholar
  23. 23.
    Rigon F, De Sanctis V, Bernasconi S, et al. Menstrual pattern and menstrual disorders among adolescents: an update of the Italian data. Ital J Pediatr. 2012;38:38.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    De Sanctis V, Bernasconi S, Bianchin L, et al. Onset of menstrual cycle and menses features among secondary school girls in Italy: a questionnaire study on 3,783 students. Indian J Endocrinol Metab. 2014;18:S84–92.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kiesner J, Martin VT. Mid-cycle headaches and their relationship to different patterns of premenstrual stress symptoms. Headache. 2013;53:935–46.CrossRefPubMedGoogle Scholar
  26. 26.
    Shehnaz SI, Agarwal AK, Khan N. A systematic review of self-medication practices among adolescents. J Adolesc Health. 2014;55:467–83.CrossRefPubMedGoogle Scholar
  27. 27.
    Dzoljic E, Sipetic S, Vlajinac H, et al. Prevalence of menstrually related migraine and nonmigraine primary headache in female students of Belgrade University. Headache. 2002;42:185–93.Google Scholar
  28. 28.
    Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52:1088–97.CrossRefPubMedGoogle Scholar
  29. 29.
    Pogliani L, Spiri D, Penagini F, Nello FD, Duca P, Zuccotti GV. Headache in children and adolescents aged 6-18 years in northern Italy: prevalence and risk factors. Eur J Paediatr Neurol. 2011;15:234–40.CrossRefPubMedGoogle Scholar
  30. 30.
    Guidetti V, Galli F, Cerutti R, Fortugno S. “From 0 to 18”: what happens to the child and his headache? Funct Neurol. 2000;15:122–9.PubMedGoogle Scholar
  31. 31.
    Guidetti V, Galli F, Termine C. Headache in children. Handbook Clin Neurol. 2010;97:739–54.CrossRefGoogle Scholar
  32. 32.
    Martin VT, Wernke S, Mandell K, et al. Defining the relationship between ovarian hormones and migraine headache. Headache. 2005;45:1190–201.Google Scholar
  33. 33.
    Sanders D, Warner P, Bȧckström T, Bancroft J. Mood, sexuality, hormones and the menstrual cycle. I. Changes in mood and physical state: description of subjects and method. Psychosomatic Med. 1982;45:481–501.Google Scholar
  34. 34.
    Keenan P, Lindamer L. Non-migraine headache across the menstrual cycle in women with and without premenstrual syndrome. Cephalalgia. 1992;12:356–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Johannes CB, Linet MS, Stewart WF, Celentano DD, Lipton RB, Szklo M. Relationship of headache to phase of the menstrual cycle among young women: a daily diary study. Neurology. 1995;45:1076–82.CrossRefPubMedGoogle Scholar
  36. 36.
    Stewart WF, Lipton RB, Chee E, Sawyer J, Silberstein SD. Menstrual cycle and headache in a population sample of migraineurs. Neurology. 2000;55:1517–23.CrossRefPubMedGoogle Scholar
  37. 37.
    MacGregor EA, Frith A, Ellis J, Aspinall L, Hackshaw A. Incidence of migraine relative to menstrual cycle phases of rising and falling estrogen. Neurology. 2006;67:2154–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Oterino A, Toriello M, Cayón A, et al. Multilocus analyses reveal involvement of the ESR1, ESR2, and FSHR genes in migraine. Headache. 2008;48:1438–50.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  • Luigi Bianchin
    • 1
  • Mauro Bozzola
    • 2
  • Antonio Battistella Pier
    • 3
  • Sergio Bernasconi
    • 4
  • Gianni Bona
    • 5
  • Fabio Buzi
    • 6
  • Carlo De Sanctis
    • 7
  • Vincenzo De Sanctis
    • 8
  • Giorgio Tonini
    • 9
  • Giorgio Radetti
    • 10
  • Franco Rigon
    • 3
  • Egle Perissinotto
    • 11
    Email author
  1. 1.Child Psychiatric UnitLocal Health and Social Care Services - ULSS 6 EuganeaPaduaItaly
  2. 2.Internal Medicine and Therapeutics, Section of Childhood and Adolescence, Foundation IRCCS San MatteoUniversity of PaviaPaviaItaly
  3. 3.Department of Woman’s and Child HealthUniversity of PaduaPaduaItaly
  4. 4.Department of Pediatrics, University of ParmaParmaItaly
  5. 5.Division of Pediatrics, Department of Mother and Child HealthAzienda Ospedaliero-Universitaria Maggiore della CaritàNovaraItaly
  6. 6.Department of Pediatrics“Carlo Poma” HospitalMantovaItaly
  7. 7.Department of Pediatric EndocrinologyOspedale Infantile Regina MargheritaTurinItaly
  8. 8.Private Accredited Hospital QuisisanaPediatric and Adolescent Outpatients ClinicFerraraItaly
  9. 9.University of TriesteTriesteItaly
  10. 10.Department of PediatricsRegional Hospital of BolzanoBolzanoItaly
  11. 11.Unit of Biostatistics, Epidemiology Public Health, Department of Cardiac, Thoracic, Vascular Science and Public HealthUniversity of PaduaPaduaItaly

Personalised recommendations