Ditans and Gepants: hope or false promise for menstrual migraine?

Menstrual migraine (MM) is a debilitating migraine subtype associated with hormonal fluctuations, often resistant to conventional treatments. Gepants, novel calcitonin generelated peptide (CGRP) receptor antagonists, and ditans, serotonin 5-HT1F receptor agonists, offer potential alternatives to triptans due to their non-vasoconstrictive properties. However, evidence supporting their effectiveness in MM remains limited. While studies suggest gepants may reduce perimenstrual migraine severity and ditans provide acute relief, their overall efficacy compared to triptans remains uncertain. Cost and side effect profiles further complicate their widespread adoption. This letter discusses the current state of evidence for gepants and ditans in MM, highlighting the need for further large-scale, real-world studies to clarify their role in treatment strategies.