Endometriosis and migraine often happen together, possibly due to the influence of female hormones and heightened pain sensitivity.

Endometriosis, a condition where uterine-like tissue grows outside the uterus, is common among reproductive-age women, leading to symptoms such as pelvic pain, painful menstruation, and infertility.

Migraine, a neurological disorder, often accompanies endometriosis. The relationship between these conditions may be influenced by female hormones and heightened pain sensitivity.

Here’s a closer look at the connection between endometriosis and migraine attacks, along with insights into treating these migraine attacks.

Migraine isn’t typically considered a direct symptom of endometriosis. However, several studies show a higher prevalence of migraine attacks among individuals with endometriosis.

One 2019 study looked at women with laparoscopically confirmed endometriosis and those without. Using a migraine questionnaire, the researchers found that migraine prevalence was significantly higher in those with endometriosis (44.7%) compared with the control group, or those without (26.8%).

Similarly, another 2021 study found that the odds of migraine attacks substantially increase in individuals with severe endometriosis. Notably, the risk is greater in cases of endometriosis with co-occurring adenomyosis, a condition where endometrial tissue grows into the muscular wall of the uterus.

Endometriosis is associated with various types of migraine, but menstrually related migraine appears to be most common.

A 2023 study of 131 women with endometriosis found that 53.4% were diagnosed with migraine. The types of migraine attacks identified included:

  • Pure menstrual migraine (18.6%): These are migraine attacks that exclusively occur during the menstrual period.
  • Menstrually related migraine (45.7%): These are migraine attacks linked to the menstrual cycle. They can happen at any time, with increased frequency around menstruation.
  • Nonmenstrual migraine (35.7%): These are migraine attacks that aren’t consistently associated with the menstrual cycle. They occur at any time of the month.

The women with both endometriosis and migraine reported more instances of dysmenorrhea (painful menstruation) and dysuria (painful urination) compared with those without migraine. Notably, the onset of headache symptoms often occurred years before the women received an endometriosis diagnosis.

Cycling female hormones, particularly estrogen, and heightened pain sensitivity may play significant roles in the connection between endometriosis and migraine attacks.

Women are three to four times more likely to experience migraine attacks.

Research indicates that females with chronic migraine often face greater disability, longer duration, higher frequency, and more work-related effects than males with the condition.

Women with either condition may be more likely to develop the other due to heightened pain sensitivity. This may be influenced by common signaling molecules like nitrogen oxide and prostaglandins, which contribute to the co-occurrence or interaction between the two conditions.

Some studies suggest common molecular mechanisms, including a gene called IFN-γ, may contribute to both migraine attacks and pelvic pain associated with endometriosis.

The treatment for endometriosis-related migraine attacks typically involves a combination of approaches aimed at managing both conditions.

Here are some general strategies to consider:

  • Pain management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may be used to alleviate headache and endometriosis pain. Your healthcare professional may recommend prescription medications, including triptans or nonsteroidal anti-inflammatory drugs (NSAIDs), for more severe migraine attacks.
  • Specialized medications: In some cases, your healthcare professional may prescribe medications specifically designed for migraine prevention, such as beta-blockers, anticonvulsants, or anti-CGRP (calcitonin gene-related peptide) monoclonal antibodies.
  • Hormonal therapies: Progestins and combined oral contraceptives (COCs) are primary therapies for endometriosis, but their use may worsen migraine attacks, especially in cases of migraine aura. They may also increase the risk of stroke. However, for healthy, nonsmoking women under 35 with migraine without aura, COCs use remains a subject of debate.
  • Lifestyle changes: Identifying and avoiding migraine triggers, such as certain foods, stress, or lack of sleep, can be beneficial. Regular exercise, stress reduction techniques, and a consistent sleep schedule may contribute to your overall well-being.

Endometriosis is a gynecological condition where uterine-like tissue grows outside the uterus, including on the ovaries, fallopian tubes, and other pelvic structures. With endometriosis, this tissue has no easy way to exit the body, leading to inflammation, pain, and the formation of scar tissue.

The association between endometriosis and migraine is common and thought to be influenced by cycling female hormones, heightened pain sensitivity, and molecular mechanisms.

If you’re experiencing symptoms of endometriosis, migraine, or both, talk with your healthcare professional about available treatments.