CGRP Migraine Drugs and Women's Health: Periods, Pregnancy, Breastfeeding, and Birth Control

Why This Review Matters

Migraine is about three times more common in women than in men, and it tends to peak during the reproductive years. That is also the stretch of life when periods, pregnancy, breastfeeding, and birth control decisions come up again and again. Hormone shifts, especially the drop in estrogen before a period, can influence the same pain pathways that CGRP (calcitonin gene-related peptide) is involved in.

CGRP-targeted drugs are now a routine part of migraine care, yet most of the trials that led to their approval were not built to answer the questions many women ask first. Can I stay on this if I want to get pregnant? Is it safe while breastfeeding? Does it help with my period attacks? Does it interact with my pill?

A team from Mayo Clinic and Georgetown University set out to gather everything published on those questions. Their narrative review, published in Headache in September 2026, searched MEDLINE and Embase, had two reviewers screen studies independently, and extracted data using standardized forms.

The CGRP Drug Families

The review covered two groups of medicines that act on the CGRP pathway. They behave very differently in the body, which matters a great deal once pregnancy and breastfeeding enter the picture.

Monoclonal antibodies

Erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti) are large antibody proteins given by injection or infusion, monthly or every three months. They are used for prevention and stay in the body for weeks to months after a dose.

Gepants

Ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), atogepant (Qulipta), and zavegepant (Zavzpret) are small-molecule drugs taken by mouth or, for zavegepant, as a nasal spray. They are used for acute treatment, prevention, or both depending on the drug, and they clear the body much faster than the antibodies.

Menstrual-Related Migraine

Many women notice that attacks around their period last longer, respond less well to treatment, and come back more often. The review found post hoc analyses of clinical trials and observational studies showing that CGRP monoclonal antibodies reduced migraine frequency both inside and outside the perimenstrual window.

In one analysis, galcanezumab was linked to a reduction of 5.1 monthly migraine days compared with 3.2 days in the comparison group (p < 0.001).

The authors also noted that even with treatment, the days around a period remained a time of relatively higher headache burden. In other words, these drugs helped overall, but period-related attacks did not disappear, and some women may still need a plan for that window.

If this is your pattern, our guide to menstrual migraine covers the hormone side in more detail.

Pregnancy

No clinical trial has tested CGRP drugs in pregnant women, and none is likely to be run for ethical reasons. What exists comes from pharmacovigilance databases (reports sent to drug safety systems) and case reports of women who became pregnant while taking one of these drugs.

Those reports have not identified a specific pattern of harm to the mother, the fetus, or the newborn. That is reassuring for someone who had an unplanned exposure, but it is not the same as showing the drugs are safe. Spontaneous reports undercount problems, rarely capture long-term child development, and cannot compare outcomes against a matched group of women who did not take the drug.

Because the antibodies stay in the body for a long time, anyone planning a pregnancy should talk with their doctor well ahead about when to stop and what to use instead. Our article on migraine treatment in pregnancy and breastfeeding reviews the options with more safety data behind them.

Breastfeeding

This is the area with the most encouraging data, at least for gepants. Phase 1 pharmacokinetic studies measured how much of each gepant passed into breast milk. The relative infant dose, meaning the share of the mother's weight-adjusted dose an infant would take in through milk, ranged from 0.04% to 0.19%.

A relative infant dose under 10% is the usual benchmark for a drug being considered compatible with breastfeeding. The gepant figures sit far below that line.

Hormonal Contraception

The review found no studies that specifically evaluated CGRP drugs in women using hormonal contraceptives. That includes whether either drug family changes how well birth control works, whether birth control changes how well the migraine drugs work, and whether the combination affects side effects.

This is a large gap given how many women of reproductive age with migraine use hormonal contraception. Until data exist, decisions rest on what is known about each drug separately, and on the separate question of which contraceptive suits a given person. For example, estrogen-containing methods are generally avoided in migraine with aura because of stroke concerns, a decision that has nothing to do with CGRP drugs but belongs in the same conversation.

Evidence at a Glance

Questions for Your Doctor

Because the evidence is thin in places, these decisions work best as a shared conversation with a clinician who knows your history. Some useful starting points:

• If I might become pregnant in the next year, how far ahead should I stop my CGRP treatment, and what would replace it?
• If I became pregnant while on one of these drugs, what monitoring would you suggest, and is there a registry I can join?
• If I plan to breastfeed, would a gepant be a reasonable option for me, given the milk-transfer data?
• My attacks cluster around my period. Is there a short-term plan for those days on top of my preventive?
• Does my type of migraine, with or without aura, affect which birth control is right for me?