Improvement in diagnostic-therapeutic care pathways for women with migraine: an Italian Delphi panel.

Italian medical experts recently came together to address a critical healthcare gap: migraine management specifically for women. Using a structured consensus process called the Delphi method, neurologists, women's health specialists, patients, and healthcare decision-makers examined how to better diagnose and treat migraines across different life stages, from adolescence through menopause. The panel identified significant shortcomings in current care, particularly noting that while migraines affect women more frequently and severely than men, treatment approaches rarely account for women's unique needs during pregnancy, breastfeeding, contraceptive use, or cancer treatment. A key finding emerged regarding acupuncture: the experts agreed that acupuncture represents an effective treatment option for pregnant and breastfeeding women with migraine. This recommendation is particularly important because many conventional migraine medications pose risks during pregnancy and lactation, leaving women with few safe alternatives during these critical periods. The panel emphasized that for young female patients, behavioral and lifestyle interventions should be attempted before medication, and that women with migraine with aura need special evaluation before starting birth control due to stroke risks. The experts also highlighted concerning knowledge gaps, noting a complete absence of guidelines for managing migraine in women undergoing fertility treatments or cancer therapy. Their recommendations call for better coordination between neurologists and other specialists like gynecologists and oncologists, comprehensive education for all healthcare providers about migraine management, and increased public awareness campaigns targeting women. If you're considering acupuncture for migraine management during pregnancy or breastfeeding, consult with a licensed acupuncturist experienced in prenatal care and inform your obstetrician.

This Italian Delphi consensus study convened migraine experts, women's health specialists, patients, and policymakers to establish female-specific diagnostic-therapeutic pathways for migraine management. Using iterative Delphi methodology, the panel identified critical gaps in clinical practice and formulated consensus statements addressing migraine care across female life stages. Key clinical recommendations include prioritizing socio-behavioral interventions before pharmacological treatment in pediatric/adolescent populations, mandatory assessment of aura status in women requiring contraception due to thrombotic risk stratification, and careful hormone-replacement therapy selection in menopausal patients. Significantly, the panel reached consensus that acupuncture constitutes an effective treatment modality for pregnant and breastfeeding women with migraine—populations with limited safe pharmacological options. The experts identified substantial literature voids regarding migraine management during assisted reproductive procedures and oncological treatment. Clinical takeaway: This consensus supports acupuncture as an evidence-informed, low-risk intervention for migraine management during pregnancy and lactation, warranting increased integration into multidisciplinary treatment algorithms for reproductive-age women. Enhanced collaboration between neurologists, obstetricians, gynecologists, and complementary medicine practitioners is essential for comprehensive female-centered migraine care.