105 Migraine with and without aura in relation to the menstrual cycle 5 Participants were followed with headache E-diaries during ≥2 menstruations in order to classify days as perimenstrual or non-perimenstrual. Menstrual migraine diagnosis could therefore by definition not be verified in a minority of patients followed for < 3 menstrual cycles. Each morning an alert was sent to all participants, which could be accessed on a mobile device or a computer. The questionnaire contained 6-31 questions, depending on the answers provided, about the presence of headache and/ or visual aura symptoms and their characteristics, use of acute medication, change in prophylactic medication, general well-being (rated on a scale from 0-10) and menstruation. Questions covered the 24 hours of the previous day (from midnight to midnight), enabling patients to enter data first thing in the morning. If the E-diary was not completed by the end of the afternoon, a reminder was sent. Entries could not be edited after completion of the questionnaire and questionnaires were time-locked after five days (for this study). Patients were encouraged to enter data daily. Patients were not excluded based on insufficient compliance to the E-diary. An automated algorithm based on ICHD-3 criteria verified for each day whether criteria for headache and migraine were met.4 A headache day was defined as a day with headache symptoms lasting ≥ 1 hour or for which acute medication was used. Migraine days were defined based on detailed characteristics as described in the ICHD-3 criteria. Additionally, days with visual aura symptoms lasting 5-60 minutes and days with triptan use were considered migraine days. By definition each migraine day was also considered a headache day. Consecutive migraine days with migraine free periods of less than 24 hours were considered as one attack. For each woman, median menstrual cycle length was calculated. Bleeding or spotting days occurring in between regular monthly periods were considered non-perimenstrual days. A distinction between perimenstrual and non-perimenstrual migraine attacks was made based on the ICHD-3 criteria and applied to the data collected with the E-diary.3, 4 Migraine attacks starting during the perimenstrual window, defined as day -2 to +3 of the menstrual cycle, were considered perimenstrual migraine attacks and all other attacks as non-perimenstrual migraine attacks. Women suffering from a perimenstrual migraine attack in two out of the first three consecutive menstrual cycles were diagnosed with menstrual migraine. A minority of patients registered only 2 menstruations, for whom the menstrual migraine diagnosis could not be established. One-time questionnaire At baseline, participants completed a one-time questionnaire about the influence of several hormonal milestones, including pregnancy, breastfeeding and oral
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