Migraine stands as one of the most consequential disabling neurological disorders confronting modern medicine, characterized by recurrent episodes of severe head pain with neurological mani-festations that substantially diminish quality of life and impose considerable socioeconomic bur-den. Contemporary epidemiological investigations consistently document a striking disparity in disease prevalence between biological sexes, with women experiencing migraine attacks at rates exceeding those in men by approximately threefold, with documented prevalence reaching 18 per-cent among adult female populations. The female migraine phenotype characteristically includes am-plified pain intensity, elevated attack frequency, and more diverse symptomatological presenta-tions. This comprehensive review synthesizes accumulated evidence illuminating the complicated relationship between biological sex, hormonal steroid signaling pathways, central nervous system function, and the spectrum of therapeutic modalities available for migraine management. The over-arching conclusion emphasizes that truly effective, patient-centered migraine management neces-sarily incorporates biological sex and individual hormonal circumstances as core organizing princi-ples influencing both disease manifestation and therapeutic response patterns.