Meta-Analysis of 13 Million Women Finds 2.3-Fold Migraine Odds Increase With Endometriosis, Visibility Gap Misses 90% of Cases

The study pooled data from 207,675 women with endometriosis and 12.96 million controls across 50 years of research. Clinic-based interviews captured migraine in 54-78% of endometriosis cases, while insurance claims over longer periods reported 18-43% and single-year billing records found fewer than 5%, indicating short-term records miss up to 90% of overlaps due to specialist silos. Researchers highlighted potential shared mechanisms via CGRP-mediated pain signaling and neuroinflammation, noting endometriosis lesions contain CGRP-sensitive nerve fibers similar to migraine pathways. This visibility gap often leads to fragmented care where pelvic pain and headaches are treated separately despite overlapping biology. Prior observational data from cohorts in Fertility and Sterility (2019) and Neurology (2021) support the association but lacked the scale to quantify record-length biases. Coordinated screening by neurologists and gynecologists could enable earlier combined management, reducing reliance on opioids or repeated surgeries. Next steps require interventional trials testing whether CGRP monoclonal antibodies approved for migraine reduce endometriosis pain scores, with endpoints tracked over 12-24 months to distinguish shared versus independent pathways.