Migraine in women: causes, characteristics, and modern treatment methods

Migraine is one of the leading causes of disability worldwide, especially among women under the age of 50 [2]. The prevalence of migraine in women is three times higher than in men, and it has unique characteristics associated with hormonal changes throughout life [2]. Understanding these features is critical for effective diagnosis and the selection of an optimal treatment strategy.

Why is migraine more common in women? The hormonal factor

The link between migraine and the female sex is deeply rooted in hormonal fluctuations. More than half of women suffering from migraine report a connection between headache attacks and the menstrual cycle [3]. There are specific types of migraine characteristic of women:

• Pure menstrual migraine: attacks occur exclusively during the perimenstrual period.
• Menstrually-related migraine: attacks are more frequent and/or severe during the perimenstrual period, but can also occur at other times of the month [2].

These hormonally-driven attacks are often more severe, prolonged, and less responsive to standard treatment compared to attacks occurring at other times [1, 3, 5]. Clinical manifestations of migraine can also change during pregnancy, the postpartum period, and lactation [2]. These features underscore the need for a personalized approach to migraine treatment in women [2].

Traditional approaches to migraine treatment in women

Initial treatment methods for menstrual migraine include general acute agents used to abort migraine. However, for many women, these therapies provide only partial relief [3].

Acute treatment:

• Non-steroidal anti-inflammatory drugs (NSAIDs) [3].
• Triptans [3].

In cases where acute treatment is not sufficiently effective, options for short-term perimenstrual prophylaxis are considered:

• NSAIDs taken during the perimenstrual period [3].
• Triptans used prophylactically during the perimenstrual period [3].
• Hormonal preparations containing estrogen to stabilize the hormonal background [3].

If these measures do not help or the menstrual cycle is irregular, continuous prophylaxis using hormonal therapy or standard anti-migraine drugs may be considered [3]. However, traditional methods of short-term prophylaxis are often ineffective due to intolerance or contraindications [5].

Innovative CGRP-targeted therapies

In recent years, a significant breakthrough in the treatment of migraine, especially menstrual migraine, has been associated with the emergence of drugs targeting the calcitonin gene-related peptide (CGRP) pathway [1]. CGRP plays a key role in the pathogenesis of migraine. These therapies include:

• Monoclonal antibodies (mAbs) to CGRP: administered by injection and intended for long-term prophylaxis. They reduce the overall frequency and severity of migraine attacks [1].
• Gepants: are CGRP receptor antagonists and can be used for both acute abortive treatment and migraine prophylaxis. Rimegepant, for example, has shown potential in the short-term prophylaxis of perimenstrual migraine [1, 5]. In one study, five women with menstrually-related migraine received rimegepant 75 mg every other day, starting two days before menstruation and continuing until two days after. This led to a significant reduction in migraine days during the perimenstrual period [5].

These new treatment methods represent a promising mechanism-oriented approach to menstrual migraine, although their role has not yet been fully defined [1]. They effectively reduce the overall migraine burden, but the perimenstrual component may remain relatively resistant to treatment [1, 4]. The lack of specialized clinical trials focusing solely on menstrual migraine is a major limitation [1].

Other modern treatment methods

In addition to CGRP-targeted drugs, there are other methods used in the treatment of migraine, including menstrually-related migraine:

• OnabotulinumtoxinA (Botox): used for the prophylaxis of chronic migraine. Studies show its effectiveness in reducing the number of headache days, although perimenstrual days may be more resistant [4].
• Repetitive transcranial magnetic stimulation (rTMS): this non-invasive neuromodulation method has shown promising results as an add-on therapy for vestibular migraine in women of reproductive age. The study showed that rTMS combined with pharmacotherapy significantly reduces the impact of headache on quality of life compared to pharmacotherapy alone [7].

Personalized approach to treatment

Given the significant differences in the clinical manifestations of migraine in women of different ages and at different life stages (pregnancy, lactation, menopause), a personalized approach to treatment is crucial [2]. Women are more likely to consult a doctor regarding migraine, which highlights their need for effective and safe treatment strategies [2]. The choice of therapy should take into account individual characteristics, comorbidities, and patient preferences to ensure the right treatment for the right patient at the right time [2].

Sources

• 1. Beyond triptans in menstrual migraine: the emerging role of CGRP-targeted therapies. (Expert opinion on emerging drugs, 2026) https://pubmed.ncbi.nlm.nih.gov/42288968/
• 2. Sex and age differences in migraine treatment and management strategies. (International Review of Neurobiology, 2022) https://pubmed.ncbi.nlm.nih.gov/36038208/
• 3. Menstrual migraine: treatment options. (Neurological Sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2014) https://pubmed.ncbi.nlm.nih.gov/24867838/
• 4. Effectiveness of anti-CGRP monoclonal antibodies and onabotulinumtoxinA in menstrually-related migraine: The unmet need of perimenstrual headache days. (Cephalalgia: an international journal of headache, 2025) https://pubmed.ncbi.nlm.nih.gov/40239029/
• 5. Short-term prevention of perimenstrual migraine with rimegepant. (The Journal of Headache and Pain, 2025) https://pubmed.ncbi.nlm.nih.gov/41225335/
• 7. Repetitive transcranial magnetic stimulation for vestibular migraine in women of reproductive age: a retrospective propensity score-matched study. (Frontiers in Neurology, 2025) https://pubmed.ncbi.nlm.nih.gov/41561339/

The information provided in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified medical professional for diagnosis and treatment prescription.