155 Migraine attack incidence in relation to ovulation 7 In the SCCS model, the ovulatory window was associated with lower incidence of migraine attacks when compared to the follicular phase (OR: 0·74, 95% CI: 0·71-0·78, p<0·001), but not when compared to the luteal phase (OR: 0·99, 95% CI: 0·94-1·04, p=0·63) (Table 4). Table 4. Results of SCCS model. Data is stratified per patient and odds-ratios are calculated for first day of migraine attack within a certain period of the menstrual cycle, in comparison to follicular phase and luteal phase as reference periods. Data of 2522 menstrual cycles from 554 patients with migraine are shown. Reference period Period of interest, OR [95% CI] Follicular phase Luteal phase Intercept 0.26 (0.25 – 0.27)*** 0.19 (0.19 – 0.20)*** Ovulatory window 0.74 (0.71 – 0.78)*** 0.99 (0.94 – 1.04) Perimenstrual window 1.29 (1.24 – 1.34)*** 1.71 (1.63 – 1.79)*** Follicular phase x 1.33 (1.27 – 1.39)*** Luteal phase 0.75 (0.72 – 0.79)*** x OR = odds-ratio; CI = confidence interval; levels of significance = *≤0.05, **≤0.005, ***≤0.001Only migraine attacks without aura were influenced by sex-hormone fluctuations during the menstrual cycle, whereas the incidence of migraine attacks with aura remained stable (Figure 4). Figure 4: Migraine incidence by day of the menstrual cycle, standardized to 28 days and calculated day of ovulation fixed on day 14. The data is subdivided into migraine attacks with aura and migraine attacks without aura. (a) Patients with migraine without aura (MO) and migraine with aura (MA) pooled. Total of 2522 menstrual cycles from 554 patients (198 MA + 356 MO). (b) Only patients with a MA diagnosis. Total of 926 menstrual cycles from 198 patients with MA are shown.
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