Migraine treatment considering gender differences

Abstract

The prevalence of migraine is higher in women than in men, especially in women after adolescence. Female hormones, especially estrogen, are greatly involved in the onset of migraine, and migraine attacks increase after a woman's menarche. In women, menstrual migraine that occurs during menstruation is generally known to be more severe and last longer than migraine attacks that occur outside of menstruation. It's also known that migraine attacks are reduced during pregnancy. There are many reports that there is a marked improvement, especially in the late pregnancy (8^th to 10^th month of pregnancy). It's said that this is because the concentration of estrogen in the blood is maintained at a high level from the second trimester (5^th to 7^th month of pregnancy) onwards, making it easier for the attacks to subside. However, it has been reported that about half of migraineurs experience a reccurence within one month after giving birth. This is thought to be due to the rapid drop in blood estrogen levels immediately after childbirth and the burden of childcare (lack of sleep, mental stress, etc.). Treatment is carried out in accordance with general migraine treatment. As an acute treatment, triptans are used to treat menstrual migraine, but as the duration of the attack is longer and more severe than normal migraine attacks, naratriptan, which is a long–acting type of triptan, is often selected. This can be treated by taking acetaminophen or NSAIDs at the same time. Regarding preventive therapy, options include the use of existing preventive drugs and CGRP–related antibody preparations that have appeared in recent years, but there are reports that they are somewhat less effective against menstrual migraines. Additionally, drugs should basically be avoided during pregnancy, but the first–choice acute phase treatment drug is acetaminophen, and when it comes to triptans, sumatriptan is often used. Although there are many reports, there is no clear evidence of safety, and triptans are used when the benefits outweigh the risks in severe migraine attacks. Propranolol, a beta–blocker, is used as a prophylactic drug. As described above, treatment especially for women, who have a large number of patients, requires detailed treatment tailored to each individual patient.