117 Migraine with and without aura in relation to the menstrual cycle 5 Clinical implications • The perimenstrual window is associated with increased susceptibility to exclusively migraine attacks without aura, both in women with MO and MA. • Pregnancy and breastfeeding are more often associated with an improvement in frequency of migraine attacks in women with MO compared to women with MA. • Prevalence of menstrual migraine was similar among women with MO and MA as majority of MA patients also suffer from attacks without aura. • For future editions of the diagnostic criteria of menstrual migraine, exclusively migraine attacks without aura should be counted as perimenstrual attacks, also in women whom experience additional migraine attacks with aura. • Sex hormone levels seems to differently effect the trigeminovascular system and susceptibility to cortical spreading depolarization. Declaration of conflicting interests The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: I.E. Verhagen, B.W.H. van der Arend, D.S. van Casteren, A. MaassenVanDenBrink and G.M. Terwindt report independent support from ZonMw (849200007) and the Dutch Brain Foundation (HA2017.01.05). A. MaassenVanDenBrink reports consultancy or industry support from Novartis, Lilly and Teva, and Allergan/Abbvie and independent support from the Dutch Heart Foundation. G.M. Terwindt reports consultancy or industry support from Novartis, Lilly and Teva, Allergan/Abbvie, and Lundbeck and independent support from the European Community, Dutch Heart Foundation, IRRF and Dioraphte. N.J.S. Thiermann and E. Tange report no conflict of interest. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by ZonMw (849200007) and the Dutch Brain Foundation (HA2017.01.05).
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