New Type of Migraine May Be cause of Iron Deficiency

Many  women who have migraine toward the end of menstruation can be best treated with iron supplements, a new study suggests.

Where it was Published:

This study was published in the journal Headache, Anne Calhoun and others, describe a new type of headache dubbed” end-menstrual migraine.”  They explain that this is “a not-uncommon yet not previously typified headache disorder, which we are simply calling ‘end-menstrual migraine’…due to its proximate occurrence with the terminal days of menstrual bleeding each month.”


The statement  describes 30 women with this condition, most of whom were found to have low levels of ferritin, suggesting that iron supplementation may be a suitable treatment.


They have also believe that end-menstrual migraine is not hormonally mediated but rather causally related to menstrual blood loss, resulting in a brief relative anemia with consequent migraine. “Further study is needed to substantiate this association, search for confounders and evaluate response to iron therapy,” they conclude.

Dr Calhoun Said this:

“This is migraine which occurs at the end of the menstrual period — maybe on the last few days of bleeding or after the bleeding has stopped,” Dr Calhoun, who runs a menstrual migraine clinic, explained to  Medical News. “It is not the same thing as menstrual migraine, which generally occurs on the day or two before menstruation or on the first day or two of bleeding and is known to be hormonally mediated. If migraine occurs 5 days or more after the onset of bleeding this is not classic menstrual migraine.”


How it can be Treated:

he explained that menstrual migraine is very common, is normally caused by the withdrawal of estrogen, and can be treated with hormone therapy.

“But this new phenomenon of ‘end menstrual migraine’ is different,” she said. “Some women have both menstrual and end-menstrual migraine. I kept coming across women with menstrual migraine. After treatment with hormones this would improve, but they would still get a headache but later on. Other women only get a headache at the end of the menstrual period, and these headaches were not responding to hormone treatment.”

She estimates that up to 20% of her patients have this type of migraine.


Dr Calhoun started to look for other ways to treat these women and started wondering about iron levels. “We know children can get headaches due to anemia, and these women are experiencing migraine after acute blood loss each month. It seemed worth investigating. Also, restless legs syndrome is common in women with migraine and has also been linked to low ferritin levels,” she said.


While there has not yet been a formal study of iron supplementation in these women, Calhoun is convinced such treatment works. “I see these patients day in day out, and I can tell you that giving them iron does make them better. Virtually all of them respond. It may take a few months and if they are very low in ferritin they may need an iron infusion. But, yes, a formal study would be the next step.”


For the current study, the authors assessed the relationship between patients with migraine occurring at the end of menstruation and their blood ferritin levels.


What they Examine:

They examined their menstrual migraine clinic’s database to find patients with migraine, regular menses, and the locally used diagnostic code of EMM, signifying the patient’s assertion that she had migraine at the end of menses as well as calendar data confirming that association. Because ferritin levels are routinely drawn in this particular clinic in such women, serum ferritin levels were available for all these patients.

Examination Results:

Results showed that among the most recently seen 119 women in the clinic, 85 had both regular menses and a diagnosis of migraine and were thus appropriate for evaluation. In this selected population, 30 women (35.3%) were confirmed to have end menstrual migraine.


Of these, 28 (93.3%) had ferritin levels that fell below the generally accepted lower desirable limit of 50 ng/mL (mean, 21.9 ng/mL), and half had levels below 18 ng/mL, the established minimum levels for women.

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