Specificity of Migraine Treatment in Women

The prevalence of migraine is higher in women than in men, with female to male ratio 3:1 in reproductive age. It is believed that sex hormones play significant role in migraine pathogenesis. Therefore, treatment of migraine in women has some specificities due to hormonal differences between sexes and due to hormonal fluctuations during menstrual cycle, pregnancy, lactation and perimenopause. Treatment of migraine during pregnancy depends on safety profile of the therapy. NSAID-s like naproxen and ibuprofen are being considered safe during the second trimester, but during the first and third trimester they may have adverse effects on pregnancy and foetus. CGRP antagonists should be avoided during pregnancy. Acetaminophen, ibuprofen, and diclofenac are considered to be safe acute therapy during breastfeeding and for preventive treatment propranolol should be used as first line therapy. Women with severe menstrual and menstrual related migraine without aura may be treated with hormonal therapy, whereas it should be avoided among patients with aura due to increased risk of stroke.