The effect of endometrial lesion removal surgery on migraine headache frequency: Preliminary results

Editor’s note: The research described below comes from a recipient of a 2025 MSC Travel Grant supporting travel to the 67th Annual Scientific Meeting of the American Headache Society. These grants reimburse travel expenses for those who have had their abstract for a presentation or poster accepted at a meeting.

By Joel Brown, PhD student, Washington University in St. Louis, US.

What is the research gap that your study addresses?

15% of women with migraine have endometriosis, a condition characterized by the growth of endometrial-like tissue outside of the uterus and a leading cause of chronic pelvic pain. One common intervention for endometriosis is surgery to remove the endometriosis lesions, but the impact of the surgery on migraine severity is unknown.

What is your research hypothesis?

This study aimed to determine the changes in headache frequency following surgical removal of endometriosis lesions.

What methodology did you use to address your research hypothesis?

Patients with endometriosis, with and without migraine, completed surveys characterizing their endometriosis and migraine symptoms (if applicable) before and 3 months after surgery. During the surgery, endometriosis lesions were excised as part of routine care.

What are the main results of your study?

Before surgery, patients with migraine (n=6) reported an average headache frequency of 17.3 +/-7 .37 per 30 days. Three months after surgery, headache frequency was reduced to 5.5 +/- 3.27 (p=0.005). Patients with migraine (n=4) showed significant decreases in endometriosis-associated pain scores (6.0 +/- 1.83 before surgery; 1.5 +/- 2.38 after surgery, p=0.006). A greater reduction in endometriosis pain was correlated with a greater reduction in headache frequency (r2=0.995, p=0.003). Interestingly, patients with (n=5) and without (n=5) migraine showed similar decreases in mean pain scores (-4.6 +/- 1.14 and -3.2 +/- 2.86, respectively, p=0.354).

What conclusions did you reach based on your results?

A reduction in headache frequency was found after lesion removal surgery and was related to the decrease in endometriosis pain. The mechanisms associated with this reduction are still unclear but could involve a change in sex hormone levels.

What are the limitations of your study?

Efforts are underway to increase the small sample size and will continue to explore the interactions between migraine and endometriosis as more data become available.

What is the relevance of your study to migraine?

Preliminary results suggest that migraine headache frequency is reduced after lesion removal surgery for endometriosis.