Sex-specific management of migraine a systematic review and consensus statement from the European Headache Federation (EHF)
Source: The journal of headache and pain
Authors: Simone Braca, Francesco Casillo, Stefanie Moreira, Esme Ekizoglu, Marte-Helene Bjork, Anna K Szewczyk, Annelies Van Dycke, Derya Uluduz, Gianluca Coppola, Christina Deligianni, Christian Lampl, Erling Tronvik, Faisal Mohammad Amin, Jan Versijpt, Kristina Ryliškienė, Margarita Sanchez Del Rio, Phil R Holland, Gisela Terwindt, Uwe Reuter, Antoinette MaassenVanDenBrink, Raquel Gil-Gouveia, Publication Date: Fri, 17 Apr 2026 06:00:00 -0400
J Headache Pain. 2026 Apr 17. doi: 10.1186/s10194-026-02350-x. Online ahead of print.
NO ABSTRACT
PMID:41998499 | DOI:10.1186/s10194-026-02350-x
Pubmed ID: pubmed:41998499
Identifiers: pmid:41998499, doi:10.1186/s10194-026-02350-x,
Paper chosen by David Finn
1 Comment
Leave a Comment
You must be logged in to post a comment.
This paper systematically reviews and synthesizes current evidence on sex-related clinical differences in migraine, including treatment outcomes and reproductive management, to provide
evidence-based recommendations, or expert consensus recommendations where high-quality data are lacking. Thirty-seven studies informed 10 evidence summaries. Acute and preventive anti-CGRP therapies show similar efficacy between sexes. For menstrual-related migraine attacks, triptans and lasmiditan are effective, with frovatriptan being recommended for short-term prevention; long-term prevention recommendations include topiramate and anti-CGRP mAbs. The authors also provide recommendations for management of migraine during pregnancy and breastfeeding. Anti-CGRP mAbs are equally effective in pre and postmenopausal women. Expert consensus emphasizes the influence of hormonal transitions on migraine expression across sexes and supports the use of acetaminophen, antiemetics, magnesium, NSAIDs, steroids, beta-blockers, amitriptyline, and calcium channel blockers as generally safe in Women of Childbearing Potential and during pregnancy, although some agents have trimester-specific limitations. Efficacy was noted for acetaminophen, sumatriptan, antiemetics, magnesium, propranolol, amitriptyline, and onabotulinumtoxin A. The authors make the important point that integrating sex-based analyses and broadening trial inclusion and more reproductive safety evidence are essential for personalized, equitable migraine care.