146 Chapter 7 The aim of our study was to conduct a large longitudinal cohort study in women with migraine and regular menstrual cycles, using our validated Leiden e-headache diary, which also includes daily menstrual cycle tracking. A subgroup of women completed urine LH surge tests across two menstrual cycles to confirm ovulation timing. METHODS Study population In this cohort study we prospectively collected data from August 2018 to October 2024 at the Leiden Headache Centre (LHC).15 Patients diagnosed with migraine filled out e-questionnaires and e-headache diaries as part of research studies or clinical care at the Leiden University Medical Centre (LUMC).16 Women aged ≥ 18 years with a migraine frequency of at least one attack per month and a regular menstrual cycle, were considered eligible. Participants were excluded if two consecutive menstrual cycles differed by seven days or more, and individual cycles were removed if the cycle length was <21 days or >35 days. Diaries of at least two menstrual cycles per patient were required and each individual cycle had to have at least 80% adherence to the e-diary. Women with chronic migraine (CM) (≥15 monthly headache days, including ≥8 migraine days) were excluded as detecting a clear pattern throughout the menstrual cycle would be challenging. To address the effect of excluding these patients, we also conducted a complete case analysis that included those with CM. We did not exclude participants based on medication use. As part of the Women Hormones Attacks and Treatment (WHAT)-hormone study, a subgroup of 31 women with menstrual migraine measured their LH surge during one or two menstrual cycles between January 2022 and September 2024. Recruitment for this subgroup was conducted through newsletters, social media and the website www.whatstudy.nl/en, where participants could fill out a registration form. Interested participants were screened for additional inclusion criteria via a telephone call. Women were excluded if they smoked, had a body mass index (BMI) > 31 kg/m², were pregnant or breastfeeding, used sex hormone-containing treatment and/or corticosteroids, or had any medical condition that could influence sex hormone levels such as polycystic ovary syndrome.
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