Endometriosis and Migraines: Coincidence or Comorbidity?

women pain

For the estimated 11 percent of American women between the ages of 15 and 44 who have endometriosis, the condition can affect everything from their digestive health to their energy levels.

Now, researchers have begun to examine the link between endometriosis and migraines. By understanding the relationship between these two seemingly disparate conditions, clinicians can work to ensure that both endometriosis and migraines are identified and treated as soon as possible.

Migraines and Endometriosis: What’s the Link?

Pain is the most common symptom of endometriosis, and can present itself in the form of dysmenorrhea, dyspareunia, chronic pelvic or lower back pain, painful urination or painful bowel movements. Rarely, endometrial tissue can form on the lungs or chest cavity and cause chest pain.

Research has revealed an association between endometriosis and painful migraine headaches. One study published in Fertility and Sterility found that adolescents who had been diagnosed with endometriosis were more likely to experience migraines (69 percent) than those without endometriosis (around 30 percent). In addition, participants with both endometriosis and migraines experienced more dysmenorrhea than those without migraines.

This strong correlation led the study’s authors to recommend that patients who present with either condition be screened for comorbidity.

Possible Hormonal Factors

But what might be responsible for this relationship? Both endometriosis and migraines share some commonalities. They tend to affect similar age groups, and women are generally more vulnerable to both migraines and endometriosis pain during menstruation.

This suggests a strong hormonal component. Specifically, the influence of progesterone and estrogen on both migraines and endometriosis, as well as increased sensitivity to pain, may lead patients with one disorder to develop the other.

According to the journal Current Pain and Headache Reports, about half of all women with migraines report an increase in migraine occurrence during menstruation. This seems to be precipitated by the abrupt fall of estrogen at the end of the luteal phase of the menstrual cycle. What’s more, early menarche seems to be a risk factor for both migraines and endometriosis.

Current Pain and Headache Reports notes that if increased sensitivity to pain plays a role in the link between endometriosis and headaches, prostaglandins or nitric oxide could be a viable treatment. Prostaglandins are believed to affect pain transmission and migraine headaches, and endometriosis is associated with a significant increase in prostaglandin production. Nitric oxide helps regulate blood flow in the brain and appears to be involved in both headaches and endometriosis.

Screening for Migraines

There’s still much we don’t know about the link between endometriosis and migraines. However, asking your patients with endometriosis about their possible tendency for headaches is a simple way to screen for migraines. In one study, researchers found that the use of the ID Migraine test helped clinicians quickly assess migraines in women with endometriosis. This study also showed that the prevalence of migraines was significantly higher in patients with endometriosis.

The symptoms and comorbidities of endometriosis are complex, and many are still being identified. By identifying and treating migraine headaches in your endometriosis patients, you can help address their pain and possibly improve their quality of life. 

By Jessica Cerretani

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