Nearly eight in 10 patients with endometriosis may also suffer from migraines, according to a new analysis revealing that the connection is frequently missed in primary care settings.
A neurology research team from Mayo Clinic presented the findings on Oct. 20 at the American Neurological Association (ANA) Annual Meeting. The results stem from a meta-analysis of 35 previous studies examining the relationship between endometriosis and migraines.
Patients with Endometriosis Face 2.3 Times Higher Migraine Risk
Endometriosis is a condition in which tissue similar to the uterine lining grows outside the uterus—most commonly on the ovaries, fallopian tubes, and pelvic peritoneum—causing severe pain and bleeding with each menstrual cycle. The condition is estimated to affect 10% to 15% of reproductive-age women worldwide. In South Korea, the number of diagnosed patients has risen sharply, growing from 56,868 in 2019 to 94,473 in 2024.
The researchers compared approximately 208,000 U.S. women diagnosed with endometriosis against a control group of 13 million healthy women. They found that women with endometriosis were 2.3 times as likely to have migraines compared to those in the control group.
Notably, reported migraine prevalence varied widely depending on the study methodology. In clinical studies evaluating symptoms through direct patient interviews, migraines were identified in up to 78% of endometriosis patients. In contrast, studies relying on long-term insurance claims data indicated prevalence rates between 18% and 43%.
In studies examining only one year of routine medical and claims records, fewer than 5% of patients had both conditions documented. "Given the link between migraine and endometriosis, migraines could serve as a signal to help identify endometriosis," the researchers noted, adding that short-term medical records could miss up to 90% of co-occurring cases.
Shared Pain Mechanisms and Molecular Pathways
The researchers suggested that migraines and endometriosis may produce pain through overlapping biological mechanisms. A primary factor identified is calcitonin gene-related peptide (CGRP), a neuropeptide released by nerve fibers that transmits and amplifies pain signals. Several current preventive and acute migraine medications function by blocking CGRP receptors.
Because endometriosis lesions contain both nerve fibers and inflammatory cells, the researchers proposed that CGRP may excessively activate pain and neuroinflammatory pathways in endometriosis as well.
"It is worth investigating whether CGRP-targeted therapies for migraine could also alleviate endometriosis pain," said study lead Yohannes Woubishet Woldeamanuel, an assistant professor of neurology at Mayo Clinic. "Follow-up research is needed to determine if a single targeted treatment could ease both conditions."
Woldeamanuel also addressed why studies based on short-term medical records demonstrated a weaker association between the two conditions.
"Women of reproductive age generally view endometriosis and migraines as separate issues and seek care at different specialty clinics," Woldeamanuel explained. "Patients need to understand that these two conditions are unlikely to coincide purely by chance. It is essential that they inform their physicians about the full spectrum of their symptoms."
