He said that an estimated 5% of women of reproductive age have endometriosis and somewhere between 15% and 19% of this age group in Europe and the USA have migraine. "In the light of the findings of the study, the two conditions together would be likely to affect around 2 in every 100 women of reproductive age."

The findings did raise some problems and concerns, Dr Ferrero said. "Women with migraine often do not seek appropriate care: for example, it has been reported that more than 4 in 5 patients who consult a physician about their headaches do not see a neurologist or headache specialist. Instead, they consult their primary care practitioner, which, for many women is their gynaecologist. In our study just over 27% of the women with endometriosis and 24% of the control patients had seen a headache specialist and this low rate of migraine assessment had resulted in low rates of specific treatment."

Dr Ferrero said that a gynaecologist must investigate headache carefully in all women with endometriosis but that headache classification should always be performed by a neurologist experienced in diagnosing migraine.

"I believe all gynaecologists should always ask their patients with known or suspected endometriosis, 'do you suffer from headaches'? If they do, then a consultation with a neurologist should be advised. When endometriosis and migraine exist together each exerts a significant and independent negative effect on a woman's quality of life, and pain and the associated symptoms of migraine can be greatly reduced with adequate diagnosis and treatment."

Dr Ferrero said that migraine, particularly migraine with aura, was known to be an independent risk factor for ischaemic stroke in women of reproductive age. Although the absolute risk of stroke was extremely low, it was important that women with endometriosis receiving hormonal treatments should have migraine investigated and diagnosed by a he
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27-Oct-2004