ObjectiveTo develop a robust statistical tool for the diagnosis of menstrually related migraine.BackgroundThe International Classification of Headache Disorders (ICHD) has diagnostic criteria for menstrual migraine within the appendix. These include the requirement for menstrual attacks to occur within a 5-day window in at least 23$\frac {2}{3}$ menstrual cycles (23$\frac {2}{3}$-criterion). While this criterion has been shown to be sensitive, it is not specific. Yet in some circumstances, for example to establish the underlying pathophysiology of menstrual attacks, specificity is also important, to ensure that only women in whom the relationship between migraine and menstruation is more than a chance occurrence are recruited.MethodsUsing a simple mathematical model, a Markov chain, to model migraine attacks we developed a statistical criterion to diagnose menstrual migraine (sMM). We then analysed a data set of migraine diaries using both the 23$\frac {2}{3}$-criterion and the sMM.ResultssMM was superior to the 23$\frac {2}{3}$-criterion for varying numbers of menstrual cycles and increased in accuracy with more cycle data. In contrast, the 23$\frac {2}{3}$-criterion showed maximum sensitivity only for three cycles, although specificity increased with more cycle data.ConclusionsWhile the ICHD 23$\frac {2}{3}$-criterion is a simple screening tool for menstrual migraine, the sMM provides a more specific diagnosis and can be applied irrespective of the number of menstrual cycles recorded. It is particularly useful for clinical trials of menstrual migraine where a chance association between migraine and menstruation must be excluded.

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识别经期偏头痛——使用统计方法改进诊断标准

目的开发一个强大的统计工具，用于诊断月经相关偏头痛。背景国际头痛疾病分类（ICHD）在附录中有月经偏头痛的诊断标准。其中包括要求在至少 23$\frac {2}{3}$ 月经周期（23$\frac {2}{3}$-标准）中的 5 天窗口内发生月经来潮。虽然该标准已被证明是敏感的，但它并不具体。然而，在某些情况下，例如确定月经发作的潜在病理生理学，特异性也很重要，以确保仅招募偏头痛和月经之间的关系不仅仅是偶然发生的女性。方法使用简单的数学模型，马尔可夫链，为了模拟偏头痛发作，我们开发了一个统计标准来诊断月经性偏头痛 (sMM)。然后，我们使用 23$\frac {2}{3}$-criterion 和 sMM.ResultssMM 分析了偏头痛日记的数据集。结果sMM 优于 23$\frac {2}{3}$-criterion 对于不同的数字月经周期，并随着更多的周期数据提高准确性。相比之下，23$\frac {2}{3}$-标准仅在三个周期内表现出最大敏感性，尽管随着更多周期数据的增加特异性增加。结论虽然 ICHD 23$\frac {2}{3}$-标准是sMM 是一种简单的月经性偏头痛筛查工具，可提供更具体的诊断，并且无论记录的月经周期数如何都可以应用。