Special considerations in the treatment of migraine in women

Nearly 32 million Americans have migraine, 24 million of whom are women who suffer with migraine throughout their lifetimes. Prior to puberty, girls are afflicted with migraine at approximately the same rate as boys, but after puberty there is an emerging female predominance. Although hormones do not entirely explain the epidemiological variation seen in migraine, estrogen certainly plays an important role. Given the hormonal changes occurring throughout a woman's life, there are many opportunities for a hormonal impact on migraine, including menarche, oral contraceptive use, pregnancy, perimenopause, and menopause. The special considerations of migraine in women will be reviewed including epidemiology, pathophysiology, diagnosis, and therapy.