To characterize the signs, symptoms, and impacts of menstrual migraine (MM), and to describe differences in intrapersonal experiences of MM compared to non-MM attacks.

Semi-structured qualitative interviews were conducted with adults with MM ( ≥4 attacks/month, at least 2/3^rd associated with menstruation, and <15 monthly headache days). Signs, symptoms, and impacts of MM were elicited, and participants rated the severity and bothersomeness of these concepts on a 0-10 numeric rating scale (higher scores indicating greater severity/bothersomeness). Participants were also asked to compare the intrapersonal experience of their MM and non-MM attacks.

Participants (n=20) had a mean(SD) age of 39.2(7.8) years and were 100% (20/20) female and 90% (18/20) White. The most common signs and symptoms were head pain (100% [20/20]), nausea, fatigue/tiredness, difficulty concentrating (each; 95% [19/20]), and sensitivity to sound (85% [17/20]). Among symptoms reported by ≥ 50% of participants, head pain and fatigue/tiredness were rated as both the most severe (8.2 and 7.7, respectively) and the most bothersome symptoms (8.6 and 8.5, respectively). The most common impacts of MM were difficulty performing in work/school (70% [14/20]), inability to function (50% [10/20]), feeling frustrated (45% [9/20]), and difficulty performing physical activities (40% [8/20]). Compared to their non-MM attacks, participants described their MM attacks as longer (73% [8/11]) and more severe (79% [11/14]), with more frequent (67% [6/9]) and more predictable symptoms (86% [6/7]).

This study identified the signs, symptoms, and impacts that characterize the MM experience. Notably, these concepts were consistent with the migraine experience; however, participants reported that their MM attacks were longer and more severe than their non-MM attacks. Understanding of the MM experience will create potential opportunities for targeted treatments and better outcomes for patients.