Understanding migraine throughout a woman's life and the role of calcitonin gene-related peptide: A narrative review.

Migraine is a common, chronic, and highly disabling neurological disorder that affects women at a higher rate than men. The frequency and severity of migraine varies throughout the stages of a woman's life. Fluctuations in sex hormones, notably estrogen, appear to influence susceptibility to migraine attacks. Unstable and declining levels of estrogen can predispose women to the onset of migraine attacks, whereas high and stable levels of estrogen can, under certain conditions, exert a protective effect. Calcitonin gene-related peptide (CGRP) signaling has emerged as a prominent mediator of migraine and is the target of several therapeutic advances in the acute and preventive treatment of migraine. Higher plasma CGRP levels are observed in women compared with men, indicating that CGRP and estrogen systems may be intertwined. The interaction of CGRP and estrogen may be a key driver in the susceptibility to migraine attacks. This review will explore migraine through the different reproductive stages of a woman's life: puberty and menstruation, pregnancy, and throughout the menopausal transition, with a focus on estrogen and its interplay with CGRP.