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A1. MigraineA1.1. Migraine without auraA1.1.1. Pure menstrual migraine without auraA1.1.2. Menstrually-related migraine without auraA1.1.3. Non-menstrual migraine without auraA1.2. Migraine with auraA1.3. Childhood periodic syndromes that are commonly precursors of migraineA2. Tension-type headacheA3. Cluster headache and other trigeminal autonomic cephalalgiasA6. Headache attributed to cranial or cervical vascular disorderA7. Headache attributed to non-vascular intracranial disorderA8. Headache attributed to a substance or its withdrawalA9. Headache attributed to infectionA10. Headache attributed to disorder of homoeostasisA11. Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structuresA12. Headache attributed to psychiatric disorderA13. Cranial neuralgias and central causes of facial pain

Diagnostic criteria:

Attacks, in a menstruating woman, fulfilling criteria for 1.1 Migraine without aura
Attacks have no menstrual relationship¹

Note:

That is, they do not fulfil criterion B for A1.1.1 Pure menstrual migraine without aura or A1.1.2 Menstrually-related migraine without aura.

Comments:

This subclassification of 1.1 Migraine without aura is applicable only to menstruating women.

The importance of distinguishing between A1.1.1 Pure menstrual migraine and A1.1.2 Menstrually-related migraine is that hormone prophylaxis is more likely to be effective for pure menstrual migraine. Documented prospectively-recorded evidence, kept for a minimum of three cycles, is necessary to confirm the diagnosis as many women over-report an association between attacks and menstruation.

Menstrual attacks are mostly migraine without aura. In a woman who has migraine both with and without aura, migraine with aura does not appear to be associated with menstruation.

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 subpopulations. Management strategies may also differ for these distinct subpopulations.

There is some evidence that menstrual attacks, at least in some women, result from oestrogen withdrawal, although other hormonal and biochemical changes at this time of the cycle may also be relevant. If pure menstrual migraine or menstrually-related migraine is considered to be associated with exogenous oestrogen withdrawal, both codes A1.1.1 Pure menstrual migraine without aura or A1.1.2 Menstrually-related migraine without aura and 8.4.3 Oestrogen-withdrawal headache should be used.

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IHS vs. ICD-10

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