13 General introduction 1 the E-diary supports shared decision-making by providing patients with real-time insights into their headache patterns. However, implementation in clinical practice is sometimes hindered by various barriers faced by physicians, such as unfamiliarity, costs, and technical issues. Despite these challenges, integrating an E-diary into any electronic health record system is relatively straightforward. Moreover, if specific requirements are met, there are reimbursement options for remote care using these validated tools. DIAGNOSIS OF MENSTRUAL MIGRAINE USING AN E-DIARY The risk of having a migraine attack is highest in women during the period from two days before the first day of menstruation to the first three days of menstruation (days -2 to +3 of the menstrual cycle).10 A migraine attack occurring during this period is referred to as a perimenstrual migraine attack (Figure 1). According to the ICHD-3 criteria, if a perimenstrual migraine attack occurs in two out of three consecutive menstrual cycles, the patient is considered to have menstrual migraine.1, 9 Sometimes, a distinction is made for those with pure menstrual migraine, where the attacks occur exclusively during menstruation. However, when adequately monitored with an E-diary, the occurrence of pure menstrual migraine seems rare (< 1%).9 Figure 1. Example of a headache diary with a perimenstrual attack. The perimenstrual period is indicated in the red-bordered box (day -2 to +3 of the menstrual cycle).
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