first 10 comorbidities (5)

The Relationship Between Migraine and Endometriosis

This article has been medically reviewed by Dr. Dan Martin

What is Endometriosis?

The endometrium is a tissue that lines the inside of the uterus and is shed during each menstrual cycle. Endometriosis is a gynecological condition characterized by growth of endometrial-like tissue outside of the uterus associated with immune dysfunction and inflammation. The endometrial-like tissue can be found in or around the intestines, rectum, ovaries, fallopian tubes, bladder, pelvic cavity and more. Women will present with symptoms such as painful periods, pain with intercourse, gastrointestinal discomfort, pelvic pain and possibly infertility. “Its exact prevalence is unknown because surgery is required for its diagnosis, but it is estimated to be present in 3% to 10% of women of reproductive age and 25% to 35% of infertile women.”1

Commonalities Between Endometriosis and Migraine

Many commonalities exist between migraine and endometriosis. A study found that migraine was 1.7 times more common in women with endometriosis than in those without the disease.2 On average, it takes 7-11 years to be diagnosed with endometriosis from the onset of symptoms and 7 years for an accurate diagnosis of migraine.3 Migraine and endometriosis are chronic pain conditions commonly exacerbated by the menstrual cycle. Pelvic pain was found to be a predictor of migraine and is also a common symptom in those with endometriosis.2 Comorbidities commonly seen with endometriosis and migraine are interstitial cystitis, irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, anxiety and depression.1 In addition, headache related disability is also higher among those with chronic migraine and endometriosis.1 

What is the Connection Between Migraine and Endometriosis?

An established understanding of how migraine and endometriosis are linked has not been determined. The relationship is most likely dependent on a number of factors including the body’s response to the endometrial-like tissue, genetics and hormonal imbalances. Interestingly, a study found that a majority of women experienced migraine attacks after their endometriosis diagnosis rather than before their diagnosis (78.8% vs. 21.2%).2 More studies are needed to further understand the connection between these two conditions.

Endometriosis, Migraine and Menstruation

Endometriosis and migraine are two conditions exacerbated by the menstrual cycle. Studies have found early menarche is a risk factor for endometriosis and migraine.2 Both conditions affect a large proportion of women in the childbearing age. In migraine, there are two separate clinical variants of menstrual migraine. Pure menstrual migraine is when the headache and other symptoms occur only during menses. Menstrually-related migraine is when headaches and other symptoms occur both during menses and at other times during the month.

Migraine and endometriosis pain are frequently intensified by menstruation. Roughly 70% of women with migraine experience a headache during menstruation. Interestingly, a large population-based survey by the Endometriosis Association found 65% of women with endometriosis reported having menstrual headaches.Menorrhagia, or heavy/prolonged bleeding during menstruation is common with both conditions. A study found that 63% of migraine patients reported a history of menorrhagia which was found to be a frequent complaint in those with endometriosis.2 

What are the Recommended Treatments for Endometriosis?

Currently, elagolix is the only FDA approved treatment for moderate to severe endometriosis pain relief. Many women use over the counter medications to combat the pain and inflammation such as ibuprofen or naproxen. Other common treatments are hormonal therapies such as birth control, progestin and other medications that reduce the amount of estrogen stimulation in the body. Surgery is a treatment for some people with endometriosis especially when pain occurs. Surgery is often conducted laparoscopically and the goal is to remove the endometrial-like tissue. Some women may have surgery multiple times because the endometrial-like tissue can grow back.

Many women diagnosed with endometriosis may have less pain after beginning an oral contraceptive. It is important to note, migraine may occur for the first time after beginning an oral contraceptive which can intensify the severity and frequency of migraine due to hormonal fluctuations.5 A healthcare provider should be made aware if the patient with endometriosis also has migraine as this may influence which types of hormonal therapy are appropriate for both conditions. Oral contraceptives should be discontinued in those who have migraine with aura and changed in those who have an increased number of migraine attacks. Continuous oral contraceptives or the progestin-only pill are better options for someone who has migraine to minimize hormonal fluctuations.

What Type of Doctor Should I See For Endometriosis and Migraine?

Migraine is best treated by a clinician that specializes in headaches but some women may choose to use their primary care provider or gynecologist. A gynecologist that specializes in endometriosis and minimally invasive gynecologic surgery is the best option for this condition. For those who do not know where to find a gynecologist that treats this condition, searching for an endometriosis center is a great place to start. In addition, a reproductive endocrinologist or a gastroenterologist may be consulted if there are fertility issues or abdominal pain due to endometriosis. A pain management specialist and a mental health professional may also be helpful for someone living with both of these conditions. Lastly, pelvic floor physical therapy may help with the pelvic pain commonly seen in endometriosis and migraine.

A Note to Patients and Providers 

Healthcare providers, especially gynecologists should be aware of the comorbidity between both conditions. Endometriosis and migraine combined likely affect 2 in every 100 women of reproductive age according to Dr. Ferrero in a 2004 article.6 Healthcare providers should screen for migraine at onset of endometriosis diagnosis or during a follow up appointment. Signs and symptoms of migraine can be discussed and should be reported to a provider if they occur. Also, providers should be aware of the risks associated with hormonal therapy and migraine. More research is needed for endometriosis, therefore those with the condition are encouraged to enroll in clinical trials by routinely checking clinicaltrials.gov.

Allied Partner Resources – The Endometriosis Foundation of America

  1. What is Endometriosis: https://www.endofound.org/endometriosis
  2. Symptoms of Endometriosis: https://www.endofound.org/endometriosis-symptoms
  3. Stages of Endometriosis: https://www.endofound.org/stages-of-endometriosis
  4. Treatment and Support: https://www.endofound.org/endometriosis-treatment-support

References 

  1. Stovner et al. 2011. Endometriosis and Headache. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165129/
  2. Yang et al. 2012. Women with Endometriosis Are More Likely to Suffer from Migraines: A Population-Based Study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307779/
  3. Sheridan A. 2021. Finding an Endometriosis Specialist. https://endometriosis.net/clinical/find-specialist
  4. Karp et al. 2011. Migraine in women with chronic pelvic pain with and without endometriosis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415219/
  5. Nyholt et al. 2009.Common Genetic Influences Underlie Comorbidity of Migraine and Endometriosis.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730957/
  6. New Italian Research Links Migraine And Endometriosis. 2004. https://www.sciencedaily.com/releases/2004/10/041030205345.htm.                                                                  Study: Ferrero S, Pretta S, Bertoldi S, Anserini P, Remorgida V, Del Sette M, Gandolfo C, Ragni N. Increased frequency of migraine among women with endometriosis. Hum Reprod. 2004 Dec;19(12):2927-32. doi: 10.1093/humrep/deh537. Epub 2004 Oct 28. PMID: 15513980. https://academic.oup.com/humrep/article/19/12/2927/2356375

 

Meet the Author: Kylie Petrarca RN, BSN


*The contents of this blog are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The writer does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.

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