ABSTRACT: Migraine is a common headache disorder for which women are likely to seek care. This primary headache disorder, which often may be debilitating, has a higher prevalence in women than in men that is likely related to times of hormonal changes throughout the reproductive life cycle, such as menarche, pregnancy, postpartum period, lactation, perimenopause, and menopause, as well as to external hormonal changes associated with the use of oral contraceptives and hormone therapy. The obstetrician–gynecologist is well positioned to recognize and treat migraine and to recognize a potential relationship between estrogen fluctuation and migraine exacerbation. Migraine frequency is likely to decrease during pregnancy, but migraine often recurs during breastfeeding. Because headache does occur during these reproductive events, a careful evaluation and possible medication change may be necessary. Women also have unique risks for secondary headache during pregnancy, particularly pregnant women with a history of migraine. Therefore, a large portion of this monograph is devoted to evaluation, management, and drug safety in pregnant or breastfeeding women.
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