Hormonal treatments and migraine characteristics across reproductive stages and transition to menopause: A cross-sectional study.

BACKGROUND AND OBJECTIVES: Hormonal treatments (HTs) are widely used among females for contraception and gynecological conditions, yet their impact on migraine phenotype remains incompletely understood. This study aimed to (1) describe HT use in a cohort of females with migraine, (2) assess migraine phenotypes across hormonal status and HT type, and (3) explore menstrual and climacteric symptoms in females with migraine HT users versus nonusers. METHODS: A cross-sectional study was conducted including females aged 18-60 years with migraine, diagnosed according to International Classification of Headache Disorders, 3rd edition, criteria who attended a tertiary headache unit in Spain. In December 2024, participants were asked to complete a structured online survey on HT use (combined oral contraceptives, progestogen-only pills, and hormonal intrauterine devices; only considered if stable for ≥3 months), reproductive status (reproductive stage [RS] or menopause transition), and menstrual or climacteric symptoms. Data were cross-checked with medical records and phone interviews. Age- and size-matched analyses compared HT users and nonusers, and comparisons among HT types were also performed. RESULTS: A total of 623 females responded to the survey; 509 were included in the analysis (mean age 44.3 ± 9.2 years), including 86 (17%) current HT users. Overall, migraine phenotype and preventive treatment use were comparable between HT users and nonusers, with no statistically significant differences after adjustment for multiple comparisons (all adjusted p-values > 0.05). Among females in the RS and regular menstrual cycles (n = 78), menstrually-related migraine was highly prevalent (67/78; 86%). In the RS group comparisons (n = 109), no differences according to HT use in migraine characteristics or menstruation-related symptoms were observed (all adjusted p-values > 0.05). Similarly, among females in the menopause transition (n = 42), no differences in migraine phenotype, preventive treatments, or climacteric symptoms were observed according to HT use (all adjusted p-values > 0.05). CONCLUSIONS: In this real-world cohort of females with migraine, stable HT was not clearly associated with differences in migraine phenotype or preventive treatment patterns across reproductive stages. Menstrually-related migraine was highly prevalent, and the menopause transition represented a period of vulnerability in a subset of patients. Larger and prospective studies are needed to confirm these findings.