Mapping the humanistic care ecosystem in medical education: development and validation of a novel multidimensional instrument (HCS-ME).

Migraine is a common primary headache disorder with a global average prevalence of approximately 14–15% []. According to the latest research based on the 2021 global burden of disease data, migraine is the leading cause of years lived with disability among women of childbearing age worldwide, highlighting its significant disease burden in specific populations []. According to ICHD-3, migraine is defined as a primary disorder characterized by episodes lasting 4–72 h, typically presenting as unilateral, moderate to severe pulsating pain that is exacerbated by routine physical activity, accompanied by symptoms such as nausea and/or vomiting, photophobia, and phonophobia []. The impact of migraine on daily life extends beyond the headache phase itself, as associated symptoms also contribute significantly to functional impairment. The prevalence of migraine varies significantly across different age groups and genders, with the highest prevalence observed between 25 and 55 years of age. Among adults, the prevalence in females is 3–4 times higher than that in males []. Menstrual migraines include pure menstrual migraine (PMM) and menstrually-related migraine (MRM). The former refers to migraines occurring exclusively in association with menstruation, beginning on days − 2 to + 3 of menstruation and at no other times of the cycle, while the latter involves migraines occurring on days − 2 to + 3 of menstruation in at least two out of three menstrual cycles, and additionally at other times of the cycle []. Abnormal activity of the central nervous system and activation of the peripheral trigeminovascular system [, ], fluctuations in estrogen levels [], prostaglandin release [], and genetic mechanisms [] play significant roles in the pathogenesis of menstrual migraine []. Previous studies from non-Asian populations have shown that compared to attacks at other times of the menstrual cycle, perimenstrual migraine attacks are more severe, more disabling, and respond less well to acute treatments [], further increasing the disease burden of migraine. First proposed in the 1970s, the estrogen withdrawal hypothesis has been the primary theory explaining menstrual migraine []. Although the association between estrogen fluctuations and the pathophysiology of migraine seems evident, its exact mechanism remains controversial. This study focused on Chinese female patients with migraine and compared the differences in clinical characteristics and responses to acute treatment between PMM and MRM. It aims to provide evidence for in-depth exploration of the pathophysiological mechanisms and precise treatment strategies of menstrual migraine in the future. This study continuously enrolled female migraine patients who visited the Headache Specialty Clinic of the First Affiliated Hospital of Soochow University from May 2023 to May 2025. A total of 468 electronic questionnaires were collected. According to the inclusion and exclusion criteria, 430 patients were finally included for analysis. Inclusion criteria were: (1) Meeting the diagnostic criteria for migraine in the third edition of the ICHD; (2) Female patients with migraine; (3) Voluntarily participate and complete the questionnaire survey. Exclusion criteria included: (1) Pregnant or lactating women; (2) Combined with other severe primary or secondary headaches; (3) Severe mental illness or cognitive dysfunction; (4) The questionnaire is incomplete or has logical contradictions. Based on the temporal relationship between migraine attacks and the menstrual cycle, the enrolled patients were further classified into two groups: (1) PMM group: migraines occurring exclusively in association with menstruation, beginning on days − 2 to + 3 of menstruation and at no other times of the cycle; (2) MRM group: migraines occurring on days − 2 to + 3 of menstruation in at least two out of three menstrual cycles, and additionally at other times of the cycle. The grouping criteria were based on the diagnostic recommendations of the International Headache Society regarding menstrual migraine. Patients whose headache attacks were not related to the menstrual cycle were classified as the non-menstrual migraine (NMM) group ( = 65), which was used for exploratory comparisons of acute treatment response. See Fig.  for the specific procedure.