Migraine attacks were more frequent in post-pubertal compared to pre-pubertal girls, while the headache characteristics did not differ between the groups, according to study results published in the European Journal of Paediatric Neurology. Findings also suggest that more attacks occur during the follicular vs the luteal phase.

The goal of the current study was to explore the association between migraine attacks and the menstrual cycle in adolescent girls, while taking into account clinical pubertal status and ovulatory cycles. In addition, the study aimed to describe headache characteristics in prepubertal, peri-pubertal and post-pubertal girls with migraine.

The researchers combined 2 different tools to determine the cycle phase and to detect anovulatory cycles: menstrual diary and progesterone saliva measurements.

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The prospective study included 47 girls (mean age 12.5 years), including 16 pre-pubertal (mean age 9.8 years), 19 peri-pubertal (mean age 12.6 years) and 12 post-pubertal (mean age 16 years) girls according to Tanner stage and/or menstrual bleeding.

The most important result of the present study is a significant increase in migraine attacks after puberty. Migraine attacks were significantly more common in post-pubertal girls (28±20.9 attacks), compared to pre-pubertal (8.8±9.3 attacks, P =.005) and peri-pubertal (10±9.8 attacks, P =.012) girls. There were no significant differences between the groups in accompanying symptoms or duration of pain.

Migraine attacks were significantly more common in follicular vs. luteal phase in peri-pubertal and post-pubertal girls (P =.030), but there were no differences in accompanying symptoms, duration of pain and aura between follicular and luteal phase.

There were significant differences in body mass index (BMI) between the groups, as the highest BMI was evident in post-pubertal girls (25.0±5.5 kg/m2), followed by peri-pubertal (19.5±2.9 kg/m2) and pre-pubertal (17.1±2.4 kg/m2) girls. In accordance with previous studies, increased BMI correlated with an increase of migraine attacks.

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The study had several limitations, according to the researchers, including the potential limitations of progesterone assays in saliva, inclusion of a well characterized group of girls, and a limited sample size.

“Puberty seems to modulate frequency and onset of migraine in girls but not the headache characteristics as a first step towards an adult pattern of migraine,” concluded the researchers.


Böttcher B, Kyprianou A, Lechner C, et al. Manifestation of migraine in adolescents: Does it change in puberty? [published online ahead of print, 2020 Feb 20]. Eur J Paediatr Neurol. 2020;S1090-3798(20)30037-4. doi:10.1016/j.ejpn.2020.02.006

This article originally appeared on Neurology Advisor