Abstract / Summary
Abstract Background Migraine is a common and disabling neurological disorder among women, and hormonal variability may influence disease expression during midlife. However, migraine trajectories across the menopausal transition remain heterogeneous and incompletely characterized. This scoping review aimed to map evidence on migraine across menopausal stages, including clinical patterns, associated factors, therapeutic approaches, and knowledge gaps. Methods Following Joanna Briggs Institute methodology, comprehensive searches were performed. Studies investigating adult women with migraine across premenopause, perimenopause, or postmenopause were included. Findings were synthesized descriptively through evidence mapping. Results Of 2,199 records identified, 41 studies published between 1993 and 2026 were included. Migraine trajectories were heterogeneous: although prevalence frequently declined after natural menopause, persistence or worsening occurred in a substantial subgroup, particularly during perimenopause or after abrupt hormonal changes. Migraine was consistently associated with vasomotor symptoms, sleep disturbances, mood symptoms, disability, and reduced quality of life. Biological evidence suggested that hormonal instability interacts with persistent neurovascular mechanisms rather than estrogen deficiency alone, while therapeutic evidence remained limited and supported individualized management. Conclusions Evidence converges toward a multidimensional model in which hormonal instability, persistent neurovascular susceptibility, and contextual clinical factors jointly shape migraine burden across the menopausal transition. These findings challenge the traditional assumption that menopause is uniformly associated with migraine improvement and provide a conceptual framework to support more individualized assessment, management, and future longitudinal research.