Beyond triptans in menstrual migraine: the emerging role of CGRP-targeted therapies

Introduction: Menstrual migraine is a common and disabling subtype of migraine, linked to hormonal fluctuations and characterized by attacks that are often more severe, longer lasting and less responsive to treatment than non-menstrual episodes. Despite its relevance, menstrual migraine remains underdiagnosed and undertreated. Areas covered: This review examines the role of therapies targeting the calcitonin gene-related peptide (CGRP) pathway in menstrual migraine. We summarize current evidence on monoclonal antibodies and gepants, focusing on their efficacy in hormonally triggered attacks and their potential advantages over traditional treatments. Expert opinion: CGRP-targeted therapies represent a promising mechanism-based approach for menstrual migraine, although their role is not yet fully defined. These treatments reduce overall migraine burden, but the perimenstrual component may remain relatively resistant. The lack of dedicated clinical trials is a major limitation. Among available options, gepants offer the greatest potential due to their flexibility for both acute and short-term preventive use. Future research should focus on time-specific treatment strategies and a broader understanding of the underlying biology, including the role of additional neuropeptides.