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Abstract Details

Relation between intervals of the menstrual cycle and presentation to the Emergency Department for headache
Headache
Headache Posters (7:00 AM-5:00 PM)
019

Hormone levels can impact the severity and frequency of migraine and tension headaches. Perimenstrual attacks, thought to be precipitated by falling estrogen levels, are more severe and refractory to treatment. Given this, we hypothesized that there is an increase in ED presentations for headache during the perimenstrual interval.

Examine the relationship between presentation to the emergency department (ED) for headache and intervals of the menstrual cycle in reproductive age women.

Using Clinical Looking Glass, all first time ED visits for the primary complaint of headache throughout the Montefiore Health System network from January 2017 to December 2019 were reviewed. Analyses were limited to women aged 18 to 42 with data regarding their last menstrual period (LMP). We approximated the phase of the menstrual cycle based on a 28 day cycle by calculating the time from the start of the LMP to ED visit. Using day 1 as the start of menstruation, menstrual intervals were defined as preovulatory (days 5-11), periovulatory (days 12-18), postovulatory (days 19-25), and perimenstrual (days 26-4).  

4,996 reproductive age women (age 29.4 +/- 7.1) with LMP data presented to the Montefiore ED from 2017 to 2019 for the primary complaint of headache. Of these women, 1154 (23.1 %) were within the perimenstrual interval, 1272 (25.5%) were preovulatory, 1003 (20.1%) were periovulatory, and 653 (13.1%) were postovulatory. Overall, only 7.2% of women were on hormonal contraceptives.  Significantly more women presented during the preovulatory period compared to the perimenstrual (z=2.797, p=0.005) and all other intervals.

A significantly greater percentage of women presented during the preovulatory interval when estrogen levels are on the rise and headaches are typically less frequent and severe. This may represent a delay in seeking care for perimenstrual attacks or may indicate factors other than hormone levels dictating when patients present for headache.

Authors/Disclosures
Crystal Jicha, MD (UC Irvine)
PRESENTER
Dr. Jicha has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for LinPharma.
Jelena M. Pavlovic, MD, PhD (Albert Einstein College of Medicine) Dr. Pavlovic has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven.