Barbanti Piero, Nappi Rossella E
Headache and Pain Unit, IRCCS San Raffaele, 00163 Rome, Italy.
San Raffaele University, 00166 Rome, Italy.
Healthcare (Basel). 2025 Jan 16;13(2):164. doi: 10.3390/healthcare13020164.
Migraines are a common neurological disorder that significantly impact women, especially during their reproductive years. Hormonal, neurological, and lifestyle factors shape migraine patterns, with fluctuations during menstruation, pregnancy, perimenopause, and menopause influencing migraine prevalence and severity. This expert opinion explores current challenges, therapeutic strategies, and future directions for personalized care, addressing the limited inclusion of women in clinical research across different life stages. In order to focus on hormonal influences, pharmacological and non-pharmacological therapies, including CGRP monoclonal antibodies, neuromodulation, and lifestyle interventions, a comprehensive analysis of literature, in particular on clinical trials, real-world studies, and guidelines on migraine management was performed. Emerging digital tools and AI-based approaches were also evaluated to improve personalized care for women with migraine. Hormonal therapies, including contraceptives and HRTs, present both risks and benefits, particularly for women with migraines with aura, highlighting the need for individualized approaches. Advances in CGRP-targeted therapies have shown effectiveness in preventing refractory migraines. Non-pharmacological treatments, such as neuromodulation, acupuncture, and lifestyle adjustments, further expand the treatment landscape. However, research gaps remain, particularly regarding hormonal influences on migraines during pregnancy and menopause. Future research should prioritize female-specific clinical trials to better understand the impact of hormonal changes on migraines. Tailored therapies combining pharmacological, non-pharmacological, and digital solutions are essential for improving care. A multidisciplinary approach integrating personalized medicine, technological advancements, and patient education is crucial to optimizing outcomes and enhancing quality of life for women with migraine.
偏头痛是一种常见的神经系统疾病，对女性影响显著，尤其是在她们的生育年龄段。激素、神经和生活方式因素塑造了偏头痛模式，月经、怀孕、围绝经期和绝经期间的波动会影响偏头痛的患病率和严重程度。本专家意见探讨了当前的挑战、治疗策略以及个性化护理的未来方向，解决了不同生命阶段女性在临床研究中纳入有限的问题。为了聚焦激素影响、药物和非药物疗法，包括降钙素基因相关肽（CGRP）单克隆抗体、神经调节和生活方式干预，对文献进行了全面分析，特别是关于偏头痛管理的临床试验、真实世界研究和指南。还评估了新兴的数字工具和基于人工智能的方法，以改善对偏头痛女性的个性化护理。激素疗法，包括避孕药和激素替代疗法（HRTs），既有风险也有好处，特别是对于有先兆偏头痛的女性，这凸显了个性化方法的必要性。针对CGRP的疗法进展已显示出预防难治性偏头痛的有效性。非药物治疗，如神经调节、针灸和生活方式调整，进一步拓宽了治疗范围。然而，研究差距仍然存在，特别是关于孕期和绝经期间激素对偏头痛的影响。未来的研究应优先开展针对女性的临床试验，以更好地了解激素变化对偏头痛的影响。结合药物、非药物和数字解决方案的定制疗法对于改善护理至关重要。整合个性化医疗、技术进步和患者教育的多学科方法对于优化偏头痛女性的治疗效果和提高生活质量至关重要。
