Perimenopause represents one of the most clinically challenging phases of migraine management — marked by erratic estrogen fluctuations that can increase attack frequency, severity, and duration, often at a time when women have limited treatment flexibility. In this session, Dr. Katherine Hamilton provides a focused clinical update on migraine during perimenopause: the underlying hormonal mechanisms driving disease course changes, evidence-based acute and preventive treatment strategies, and the nuanced role of hormone therapy in this population. Particular attention will be given to patient selection, treatment sequencing, and how to counsel women navigating both escalating migraine burden and the broader hormonal transition of midlife.

Katherine T. Hamilton, MD, is an Assistant Professor of Neurology at MedStar Georgetown University Hospital, where she practices as part of the MedStar Georgetown University Hospital Headache Center. Board-certified in both neurology and headache medicine, Dr. Hamilton specializes in the comprehensive, multidisciplinary management of headache disorders in adults, with particular clinical and research focus on hormonal contributions to migraine, migraine across the female lifespan, and treatment during pregnancy and perimenopause. She has published peer-reviewed research on migraine treatment in pregnancy, the effects of CGRP inhibitors, and integrative approaches to headache care, and is an active member of the American Headache Society. Dr. Hamilton is recognized for her individualized, multidisciplinary treatment approach — incorporating pharmacologic management, procedures, devices, and behavioral strategies to optimize outcomes for women with complex migraine presentations.