Headache最新文献

{"title":"Thyroid dysfunction and migraine across racial and age groups: A multinational cohort study.","authors":"Isaac Bai, Niki Mascarenhas, Kritika Maharjan, Han Wang, Chien-Chih Chou, I-An Lai, Ching-Heng Lin, Chien-Hsiang Weng","doi":"10.1111/head.70173","DOIUrl":"10.1111/head.70173","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether thyroid dysfunction, including hypothyroidism and hyperthyroidism, is associated with migraine across racial and age groups using a large, multinational electronic health record database.</p><p><strong>Background: </strong>Thyroid disorders are highly prevalent worldwide, with hypothyroidism affecting over 200 million individuals and hyperthyroidism affecting approximately 2.5% of adults. Migraine is a leading cause of disability globally. Prior studies have suggested potential links between thyroid dysfunction and migraine, but evidence has been limited by small sample sizes, restricted population diversity, and inadequate control of confounding. Whether associations differ by thyroid subtype, race, or age remains unclear.</p><p><strong>Methods: </strong>We performed two parallel retrospective cohort analyses within the TriNetX Global Collaborative Network, comprising over 200 million patients across 21 countries, using patient records from January 2004 to December 2024. Adults aged 18-100 years with hypothyroidism or hyperthyroidism, defined by ≥3 clinical encounters within 20 years, were identified. Individuals with psychiatric disorders (including mood, anxiety, and stress-related disorders), sleep disorders, epilepsy or recurrent seizures, or known migraine-related genetic mutations were excluded. Each thyroid cohort was compared with a control group without thyroid disease, with groups balanced on key demographic and clinical characteristics including age, sex, and hypertension; beta-blocker use was additionally considered in the hyperthyroidism cohort. The primary outcome was diagnosis of migraine (International Classification of Diseases, 10th Revision, code G43) within 5 years of index date. Subgroup analyses were conducted by race (Caucasian, African American/Black, Asian) and age (18-40, 40-65, 65-100 years). Sensitivity analyses assessed robustness to alternative visit thresholds and expanded covariate adjustment.</p><p><strong>Results: </strong>A total of 33,327,750 patients were included in the hypothyroidism analysis and 28,182,377 in the hyperthyroidism analysis. Baseline differences between groups were minimized after cohort balancing. Hypothyroidism was associated with higher odds of migraine across all racial groups, strongest among African American/Black (odds ratio [OR] 2.04; 95% confidence interval [CI] 1.91-2.17), followed by White (OR 1.93; 95% CI 1.89-1.96) and Asian (OR 1.83; 95% CI 1.69-1.98). Hyperthyroidism was similarly associated with increased migraine odds, most prominently among White (OR 1.64; 95% CI 1.59-1.70), with smaller but significant associations in African American/Black (OR 1.28; 95% CI 1.14-1.44) and Asian (OR 1.18; 95% CI 1.07-1.29). Elevated odds were observed across all age strata, generally increasing with age. Findings were consistent in sensitivity analyses.</p><p><strong>Conclusion: </strong>In this large, multinational real-world study, both hy","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2020-2031"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Headache Innovation Challenge: An outgrowth of the AHS/NINDS Headache research priorities.","authors":"Jenn Vallimont, Rashmi B Halker Singh, Larry Charleston, Amy A Gelfand","doi":"10.1111/head.70230","DOIUrl":"10.1111/head.70230","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1956-1957"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Pharmacologic Treatment for Migraine Prevention in Adults: Report of the AAN Guidelines Subcommittee and the American Headache Society.","authors":"Tamara Pringsheim, Don B Smith, Sarah Tanveer, Werner J Becker, Rebecca Burch, Lara J Cooke, Todd Fenton, Jeff J Fletcher, Gillian L Gordon Perue, Andrew D Hershey, Jeffrey L Jackson, Shirley Kessel, Elizabeth W Loder, Mia T Minen, Maryam Oskoui, Vijay K Ramanan, Michelle Murren, Todd J Schwedt, Stephen D Silberstein, Kylie A Botchway-Doe, Heather M Silsbee, Sonja Potrebic","doi":"10.1111/head.70200","DOIUrl":"10.1111/head.70200","url":null,"abstract":"<p><strong>Background and objectives: </strong>This systematic review (SR) provides updated evidence-based conclusions regarding the use of pharmacologic migraine prevention in adults to inform a new joint American Academy of Neurology (AAN) and American Headache Society practice guideline.</p><p><strong>Methods: </strong>A multidisciplinary panel conducted an SR following the 2017 AAN Clinical Practice Guideline Process Manual. Randomized controlled trials evaluating pharmacologic preventive treatments for adults with episodic or chronic migraine were included. Searches encompassed MEDLINE, Embase, and ClinicalTrials.gov from database inception through June 6, 2024. Studies were screened in duplicate, with dual independent risk-of-bias assessment. Outcomes included change in monthly headache days, ≥50% responder rate, and validated patient-reported quality of life (QOL) measures. Raw mean differences, standardized mean differences, and risk ratios were calculated. A modified Grading of Recommendations Assessment, Development, and Evaluation process was used to classify certainty of evidence.</p><p><strong>Results: </strong>A total of 217 studies met inclusion criteria. For episodic migraine, high-confidence evidence showed that galcanezumab and erenumab are more effective than placebo in reducing headache frequency. Moderate-confidence evidence supported benefit from atogepant, eptinezumab, fremanezumab, propranolol, topiramate, and valproate. Several additional oral agents including amitriptyline, bisoprolol, flunarizine, fluoxetine, levetiracetam, metoprolol, nifedipine, pizotifen, and telmisartan had low-confidence evidence suggesting possible benefit. For chronic migraine, high-confidence evidence supported reductions in headache frequency with fremanezumab, galcanezumab, and onabotulinumtoxinA. Moderate-confidence evidence supported benefit from atogepant, eptinezumab, erenumab, topiramate and valproate. Across both episodic and chronic migraine populations, erenumab, fremanezumab, galcanezumab, eptinezumab, rimegepant, atogepant, topiramate and onabotulinumtoxinA demonstrated improvements in patient-reported QOL outcomes on validated instruments. Evidence comparing active treatments was limited and generally of low or very low confidence, restricting conclusions about comparative effectiveness.</p><p><strong>Discussion: </strong>This SR provides a comprehensive synthesis of evidence on pharmacologic migraine prevention in adults. High- and moderate-confidence findings confirm the efficacy of several established and newer preventive therapies and demonstrate improvements in patient-reported outcomes across multiple validated measures. These conclusions informed the development of evidence-based recommendations, presented in a companion publication, to guide clinicians in selecting preventive medications for adults with episodic and chronic migraine.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1971-1990"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interictal serum L-kynurenine and PACAP-38 levels in relation to allodynia and migraine subtypes.","authors":"Enes Durak, Aslı Aksoy Gündoğdu, Savaş Güzel, Ahsen Yılmaz","doi":"10.1111/head.70143","DOIUrl":"10.1111/head.70143","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the relationship between serum levels of L-kynurenine (L-KYN) and pituitary adenylate cyclase-activating polypeptide-38 (PACAP-38), two molecules implicated in migraine pathophysiology and migraine subtypes (episodic and chronic), as well as the presence of allodynia. We hypothesized that dysregulation of the kynurenine pathway and prepro-pituitary adenylate cyclase-activating polypeptide (PACAP) signaling would be reflected in altered serum L-KYN and PACAP-38 levels across migraine subtypes and in relation to allodynia.</p><p><strong>Background: </strong>Migraine is a complex neurological disorder characterized by central sensitization and trigeminovascular activation. Although the kynurenine pathway and PACAP-38 have been implicated in migraine pathophysiology, their associations with migraine subtypes and allodynia remain insufficiently understood.</p><p><strong>Methods: </strong>In this observational cross-sectional study, a total of 137 patients diagnosed with migraine who presented to the neurology outpatient clinic of a tertiary university hospital, and 40 age- and sex-matched healthy volunteers as a control group, were included. Interictal serum L-KYN and PACAP-38 levels were measured in all participants using the enzyme-linked immunosorbent assay. Clinical assessments comprised the Beck Depression Inventory, Beck Anxiety Inventory, MIDAS, Allodynia Symptom Checklist, and a visual analogue scale. Data analyses included nonparametric tests, correlation analyses, and multivariable logistic and robust regression models.</p><p><strong>Results: </strong>Interictal serum L-KYN and PACAP-38 levels were significantly lower in patients with migraine compared with controls (PACAP-38: H(2) = 84.742, p < 0.001; L-KYN: H(2) = 68.991, p < 0.001), with numerically lower levels in chronic migraine than in episodic migraine. Both molecules showed strong discriminatory ability between patients with migraine and healthy controls (area under the curve = 0.977 for PACAP-38; area under the curve = 0.922 for L-KYN). A strong positive correlation was observed between serum L-KYN and PACAP-38 levels (ρ = 0.772, p < 0.001). Aura (odds ratio = 4.6, 95% confidence interval [1.3 to 16.2], p = 0.017) and secondary/high school educational level (odds ratio = 6.8, 95% interval [1.5 to 31.3], p = 0.015) emerged as independent predictors of allodynia.</p><p><strong>Conclusion: </strong>Interictal serum L-KYN and PACAP-38 levels are associated with migraine subtypes and allodynia, with potential utility as clinically relevant peripheral indicators associated with migraine-related neurobiological processes.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2054-2065"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and tolerability of transnasal evaporative cooling for the acute treatment of migraine in an at-home setting: A randomized, double-blind, sham-controlled, decentralized clinical trial.","authors":"MaryAnn Mays, Kristina M Fanning, Stewart J Tepper","doi":"10.1111/head.70184","DOIUrl":"10.1111/head.70184","url":null,"abstract":"<p><strong>Objectives/background: </strong>Transnasal evaporative cooling (TNEC) is thought to modulate activity in the sphenopalatine ganglion and maxillary division of the trigeminal nerve. The safety, tolerability, and potential for therapeutic benefits of TNEC in adults with migraine have not been assessed in a fully decentralized setting. Our objectives were to determine the safety and tolerability of a TNEC device in adults with migraine and generate hypotheses for testing in studies designed to assess efficacy.</p><p><strong>Methods: </strong>This prospective, double-blind, sham-controlled, randomized, decentralized clinical trial was conducted in the United States between November 2023 and June 2024. Eligible adults 18-65 years of age who self-reported migraine for ≥1 year were randomized to one of three active treatment groups (4, 6, or 10 L/min of dehumidified air) or to a sham control (2 L/min of ambient air delivered intermittently for ~10% of total time). Tolerability was measured by the percentage of participants who discontinued their treatment session due to discomfort. The assessment of TNEC treatment effects was hypothesis-generating; reported p-values are nominal. The trial was registered at clinicaltrials.gov (NCT06051604).</p><p><strong>Results: </strong>Participants (N = 137) had a mean (SD) age of 39.4 (10.1) years, 79.6% (109/137) were female, and 85.4% (117/137) were White. The most common adverse events were rhinorrhea (2.2% [3/137]) and nasal irritation, ear pressure, runny nose, and sore throat (each 1.5% [2/137]). No participants (0% [0/128]) discontinued treatment early due to discomfort. At 2 h posttreatment, 57.6% ([19/33] 95% confidence interval [CI] = 39.2-74.5) of participants in the sham group had pain relief compared with 48.4% ([15/31] 95% CI = 30.2-66.9) of participants who received 4 L/min TNEC (p = 0.462), 61.8% ([21/34] 95% CI = 43.6-77.8) of those who received 6 L/min (p = 0.727), and 70.0% ([21/30] 95% CI = 50.6-85.3) who received 10 L/min (p = 0.306). The percentage of participants with pain freedom at 2 h posttreatment was higher in the TNEC 10 L/min group than in the sham group (33.3% [10/30] vs. 12.1% [4/33], p = 0.043).</p><p><strong>Conclusions: </strong>Treatment with TNEC was safe and feasible in a decentralized setting, and it was tolerable at high flow rates. Observed treatment effects in the acute treatment of migraine need to be confirmed in larger, adequately powered clinical trials.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2078-2089"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of hypertension after CGRP antagonist treatment in migraine: A systematic review and meta-analysis.","authors":"Kunhee Kim, Kihun Kim, Su-Yeon Cho, Yujin Kwon, Won Kyu Kim, Chaeseong Lim, Won Ho Cho, Dokyoung Kim, Yun Hak Kim, Tae-Jin Song","doi":"10.1111/head.70148","DOIUrl":"10.1111/head.70148","url":null,"abstract":"<p><strong>Objectives/background: </strong>This study aimed to systematically summarize and pool the available evidence on the risk of incident hypertension associated with calcitonin gene-related peptide (CGRP)-targeted therapies. CGRP-targeted therapies have emerged as effective preventive treatments for migraine; however, concerns have been raised regarding their potential hypertensive effects. Prior studies have been limited by small sample sizes, inconsistent definitions of hypertension, and incomplete trial inclusion.</p><p><strong>Methods: </strong>We systematically searched MEDLINE, Embase, and ClinicalTrials.gov up to September 25, 2024. We included randomized controlled trials comparing CGRP-targeted therapies with placebo or another intervention arm in adult patients with migraine. The primary outcome was incident hypertension as defined by each individual study. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias 2 tool and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>Eight publications or trial reports, comprising 19 underlying randomized controlled trials, were included. The pooled relative risk (RR) for hypertension with CGRP-targeted therapies versus control was 0.91 (95% confidence interval [CI] 0.58-1.43; I² = 0.0%), indicating no statistically significant increased risk. The certainty of evidence for this outcome was rated as very low. Erenumab showed no significant increase in risk (RR 0.71, 95% CI 0.30-1.70), whereas galcanezumab also showed no statistically significant association (RR 1.14, 95% CI 0.54-2.39).</p><p><strong>Conclusion: </strong>CGRP-targeted therapies were not associated with a statistically significant increase in hypertension risk in patients with migraine, particularly among relatively healthy populations enrolled in short-term randomized controlled trials. However, the certainty of evidence was very low, and possible variation across agents warrants further study. Longer term comparative studies and real-world observational studies with standardized blood pressure monitoring are needed to confirm these findings and better define hypertension risk in higher risk patient subgroups.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2129-2137"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondrial migraine: A multicenter study based on mitochondrial diseases presenting as encephalopathy and/or myopathy.","authors":"Changping Yan, Shu Zhang, Pei Zhang, Junbin Zhang, Yang Liu, Huanfen Zhou, Haishan Jiang, Zhaoyong Zhang, Junhong Guo, Wei Zhang, Feng Liang, Zhangyu Zou, Jialin Chen, Weian Chen, Xucong Lu, Liqiang Yu, Wei Xie, Chenghui Pi, He Zhao, Yusha Liu, Jiayi Ma, Sai Gao, Shengyuan Yu, Shiwen Wu","doi":"10.1111/head.70225","DOIUrl":"https://doi.org/10.1111/head.70225","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to investigate the clinical features of migraine in a cohort of patients with mitochondrial disease (MD) presenting as encephalopathy and/or myopathy, and to explore the potential association between migraine and mitochondrial dysfunction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;MDs comprise a heterogeneous group of disorders characterized by impaired mitochondrial oxidative phosphorylation. The high frequency of migraine among patients with MD presenting as encephalopathy and/or myopathy suggests a potential connection between migraine pathogenesis and mitochondrial dysfunction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this multicenter cross-sectional real-world study, 48 genetically confirmed patients with MD presenting as encephalopathy and/or myopathy were included from seven medical centers in China between January 2020 and March 2023. A structured questionnaire was utilized to collect demographic data, comprehensive clinical information related to MD, and detailed headache information. The frequency, clinical characteristics, and potential factors associated with migraine were analyzed. Furthermore, the frequency and characteristics were compared with data from a population-based survey on primary headaches. According to ICHD-3, the concept of \"acute headache preceding or associated with focal neurological deficits and/or seizures (AHF)\" was introduced under ICHD-3 6.8.2 Headache attributed to mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). In patients with MELAS, the frequency and characteristics of migraine in AHF-positive patients were further evaluated and contrasted with those in AHF-negative patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 1-year frequency of migraine in this cohort was 48% (23/48) (95% confidence interval [CI]: 34%-62%), markedly higher than the 1-year prevalence in the general population (9%, 95% CI: 9%-10%). Epilepsy (adjusted odds ratio: 5.73, 95% CI: 1.11-43.67, p = 0.036) and elevated resting blood lactate concentration (adjusted odds ratio : 1.54, 95% CI: 1.05-2.43, p = 0.026) were independently associated with migraine. Additionally, ancillary tests performed in specific patient subgroups revealed a higher incidence of electroencephalography abnormalities in the migraine-positive group (p = 0.025). Among 29 patients with MELAS, 12 experienced AHF and all were diagnosed with migraine (12/12, 100%), exhibiting a notably high incidence of typical migraine aura (6/12, 50%). In contrast, five of the 17 AHF-negative patients were diagnosed with migraine (5/17, 29%), and only one of these patients had typical migraine aura (1/5, 20%). The mean Numerical Rating Scale score for migraine was higher in AHF-positive patients than in AHF-negative patients (7.3 ± 1.3 vs. 5.7 ± 1.5; t = 2.23, p = 0.042).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In patients with MD presenting as encephalopathy and/or myopathy, the 1-year frequency of migraine was more than five time","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cabergoline-induced SUNCT-like headache.","authors":"Marina Romozzi, Francesco Doglietto, Martina Petracca","doi":"10.1111/head.70237","DOIUrl":"https://doi.org/10.1111/head.70237","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-calcitonin gene-related peptide treatments in women's health: Gaps and clinical evidence in menstrual-related migraine, pregnancy, lactation, and hormonal contraception: A narrative review.","authors":"Jelena Pejic, Jeya Anandakumar, Lisa A Marks, Rashmi B Halker Singh, Jessica Ailani","doi":"10.1111/head.70195","DOIUrl":"https://doi.org/10.1111/head.70195","url":null,"abstract":"<p><strong>Objective: </strong>This study was conducted to review and synthesize current evidence on anti-calcitonin gene-related peptide (CGRP) therapies in women with menstrual-related migraine, during pregnancy and lactation, and while using hormonal contraception.</p><p><strong>Background: </strong>Migraine disproportionately affects women, with prevalence peaking during reproductive years when hormonal fluctuations modulate neurovascular and nociceptive pathways, including CGRP signaling, that contribute to migraine susceptibility. Despite the established efficacy of anti-CGRP therapies-including monoclonal antibodies (erenumab, fremanezumab, galcanezumab, and eptinezumab) and gepants (ubrogepant, rimegepant, atogepant, and zavegepant)-evidence regarding their use across critical reproductive health contexts remains limited.</p><p><strong>Methods: </strong>A systematic search of MEDLINE and Embase was conducted using MeSH terms and keywords related to migraine, CGRP-targeted therapies, and reproductive health contexts. Studies were screened independently by two reviewers. Data were extracted using standardized forms and synthesized narratively by clinical domain.</p><p><strong>Results: </strong>Sixteen studies met inclusion criteria. For menstrual-related migraine, post hoc analyses and observational studies demonstrate that CGRP monoclonal antibodies reduce migraine frequency both during and outside the perimenstrual window (galcanezumab: -5.1 vs. -3.2 days, p < 0.001), although the perimenstrual period remains a time of relatively higher headache burden despite treatment. Pregnancy data are limited to pharmacovigilance analyses and case reports of unintended exposures, which have not identified specific patterns of maternal, fetal, or neonatal toxicity. Phase 1 pharmacokinetic studies demonstrate minimal gepant transfer into breast milk (relative infant doses, 0.04%-0.19%), well below the 10% safety threshold, although no human lactation data exist for CGRP monoclonal antibodies. No studies specifically evaluated anti-CGRP therapies in women using hormonal contraceptives.</p><p><strong>Conclusion: </strong>Substantial evidence gaps exist across all reproductive health contexts examined. Prospective trials in menstrual-related migraine, pregnancy registries, lactation studies assessing infant outcomes, and research examining interactions with hormonal contraceptives are needed to optimize migraine care for women.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guest editorial on \"Anti-CGRP treatments in women's health: Gaps and clinical evidence in menstrual migraine, pregnancy, lactation, and hormonal contraception\".","authors":"Susan W Broner","doi":"10.1111/head.70218","DOIUrl":"10.1111/head.70218","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}