AAN 2026 | Migraine management in women: hormonal transitions, pregnancy, and perimenopause

Thank you so much for asking that. That is such an exciting session at AAN. We’re going to have this win and my co-director who is leading this section so wonderfully for the particular spotlight is a chair, Dr Christine Esper, and doing amazing work already. I had a little glance at what my colleagues are going to present from all different sections of neurology. And it’s so much learning, including what are the proper doses for different people, including do we need to start thinking about those for men and women in movement disorder, for example? I’m looking forward to those answers from my colleagues. But for headache, I’m also a chair of the Women’s Health Section at the American Headache Society. I see it and we’re working very hard on developing proper resources for education together with AAN, IHS, International Headache Society did an amazing job very recently publishing how to treat headache during pregnancy. Nice, nice guidelines. So I would love to give updates on that. The American Headache Society, and I’m going to talk about that, gave wonderful consensus guidance about keeping screening women at least annually on headache and do they have migraine. And we have excellent tools for that. One of our favorite ones, it’s called the PIN migraine diagnosis, where three questions which we’re going to talk about can diagnose migraine in a big percentage of people. So it would not be a dramatic burden on clinicians that would be doing that screening, but really can help. Because migraine, especially in young women, 18 to 44 years of age, is one of the leading causes of disability worldwide. So 1.6 billion people have migraine in the world. One in four households is affected by headache in the United States. And we’re really working all together on women’s health because women have more frequent migraine in the population, up to about 18%, whereas men is less. And we do need to worry about supporting them every step of the way. So many people, one in three approximately, they have their first migraine attack about the time when they start their menstrual cycle. We do know that migraine around the menstrual cycle can be more resistant to treatment than at other times. In addition to that, how do we prepare people for pregnancy? It’s amazing data. And when I first saw it, it was heartbreaking to me that people, they choose not to have a family because they had migraine and they did not know how treatment would affect the baby during pregnancy. And there is beautiful uplifting data on about 80-90% of people who could improve migraine-wise during pregnancy because of these hormonal changes. Sometimes we think it’s like the baby helps during this time. But then on another hand, if a person is not planning to have a family, we also need to be supportive at this time. And what are the methods for this? We support, we discuss with every patient, we’re planning a family, we’re not planning a family, if they’re in childbearing age, but we have to ask because we just regroup and we have tools right now in headache medicine for any of those cases if we know the plan is, we have patient-centered medicine and we support our patients who live with migraine and other headache disorders every step of the way. Whatever they decide to do, we should be there for them. So we’re really happy with research developments. We need to do more research because we are lacking research on things like what is absolutely safe during pregnancy. We know what is safer. And then post-pregnancy, if someone has a baby and sleep gets disturbed, what can we use if someone is lactating, for example, and treatment of migraine during breastfeeding? We have wonderful materials. And then migraine and perimenopause, postmenopause for women is a big issue right now. Is hormonal therapy safe? How do we use it safely? So it’s a lot of super hot topics right now. And I hope to see so many people at our session because it’s going to be great. Even with this little moment when I look through other specialists’ slides and oh my goodness, I cannot wait to learn more. So I hope it will be a so, so full room and we’re going to have interactions and discussions too.

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