Migraine affects women at various life stages, with its frequency and severity influenced by fluctuations in ovarian hormones. The pathophysiology of migraine involves activation of the trigeminovascular system, brainstem regions, and diencephalic nuclei, with neurotransmitters and neuropeptides like serotonin(5-HT), gamma-aminobutyric acid (GABA), noradrenaline, and calcitonin gene-related peptide (CGRP) playing key roles in maintenance of pain. Estrogen modulates these pathways and has a significant impact on migraine pathophysiology in females. Menstrual migraines, linked to estrogen withdrawal and prostaglandin release, can be managed with short-term prophylactic therapies such as selective serotonin agonists, initiated a few days before the expected onset of menstruation, with nonsteroidal anti-inflammatory drugs, or triptans for breakthrough headaches. During pregnancy, migraines often subside due to stable hormone levels, while perimenopause can exacerbate symptoms. Breastfeeding may improve migraine symptoms temporarily. Hormone replacement therapy can reduce migraine frequency in women during perimenopausal period. A tailored, individualized approach is essential for effective management of migraines in women.
Egodage et al. (2025) studied this question.