Evolving Care Pathways for Women with Migraine in Italy: Results from a National Survey

Abstract

Background. Migraine predominantly affects women with prolonged and more severe episodes that severely compromise their quality of life. Despite its burden, diagnostic-therapeutic pathways specifically designed for women are currently lacking, and care for women with migraine remains fragmented. By expanding the results obtained from a recent Delphi consensus study, we aim to identify key unmet needs and propose expert-driven recommendations to address female-specific migraine care in Italy. Methods. We conducted a national survey in which the items used in the previous Delphi study were administered to a broader cohort of Italian healthcare professionals (HCPs). The survey was administered to 125 HCPs; of those, 92% were neurologists. Results. Diagnostic delays, insufficient multidisciplinary collaboration, and heterogeneous care emerged for women with migraine across Italy. Respondents endorsed parental awareness and socio-behavioral approaches for pediatric patients, careful evaluation of thrombotic risk for contraceptive choice, systematic assessment of migraine history and new-onset migraine during pregnancy and breastfeeding, and appropriate selection of hormone replacement therapy during menopause. Close monitoring of migraine symptoms is encouraged in oncological patients and women undergoing assisted reproduction, although evidence and guidelines for these patient subsets are currently lacking. Across all settings, the neurologist emerged as the central medical reference figure from adolescence onward, working in close collaboration with gynecologists, pediatricians, and oncologists as appropriate. Strengthening continuity of care, enhancing multidisciplinary collaboration, expanding professional training, and promoting awareness initiatives are considered the key strategies to optimize migraine care in women. Conclusions. Based on the respondents' answers, we propose practical frameworks that outline migraine care pathways tailored to specific female life stages and health conditions. Efforts should prioritize the design of targeted studies to overcome the identified evidence gaps and pave the way for more structured models.