Migraine in women: a review

Purpose of review The purpose of this review is to provide an update on the clinical course and management of migraine in women. Recent findings Migraine is two to three times more prevalent in women who report a longer, more severe attacks with more disability, an increased risk of recurrence, and a longer recovery period. Consequently, women use more acute and preventive medications, have more comorbid conditions and are more likely to run a chronic disease course. Real-life experience and evidence suggest that onabotulinumtoxinA and the newer generation antibody treatments against the calcitonin gene-related peptide (CGRP) ligand and its receptor are highly effective in the management of migraine in women. Pregnancy, breast feeding, and menstrual cycles should be taken into account when treating women with migraine. Topiramate and sodium valproate should be avoided in women of childbearing age (WCBA). Hormonal options can be considered in menstrual or menopausal migraines. NSAIDs and prostaglandins such as mefenamic acid can be used at onset of menstrual migraine. Venlafaxine can be effective in menopausal migraine while also treating the vasomotor symptoms. Migraine usually improves during pregnancy; however, if required nonpharmacological options should be considered. Summary Effectively managing migraine in women of productive and reproductive age, can reduce the socioeconomic burden of this debilitating disease.