Migraines and Menopause: Signs That You Shouldn't Ignore

When it comes to menopause symptoms, hot flashes and night sweats seem to grab most of the headlines and attention. But if you’ve started to experience more headaches than usual, or they’re a lot more painful than they used to be, you’re right to wonder if they’re one of the many  less-talked-about symptoms of this hormonally chaotic life stage. 

Migraines—those intense, throbbing skull-crushers—can be truly disabling, lasting multiple hours or longer and making it almost impossible to go about your day. And yes, migraines and menopause are connected. Migraines are more common in women in general (around 75 percent of people with migraines are women) and can be triggered by the same hormonal changes that occur leading up to menopause.

But you don’t need to take a grin and bear it approach to menopause-related migraines. Read on to find out why they happen and the best treatments and lifestyle changes to help you feel better, especially with the support of a trained menopause specialist.

The Connection Between Migraines and Menopause

To understand the link between migraines and menopause, you first need to understand the hormone changes that happen during perimenopause (the period leading up to menopause) and then during menopause itself. “We have long known about "menstrual migraines"—the moniker for the hormone fluctuations of periods regularly triggering migraines for some women.  Similarly the hormone fluctuations in perimenopause and menopause can trigger migraines and can be a challenge to manage,” says Kathleen Jordan, MD, Chief Medical Officer at Midi Health. 

From puberty through your 20s and 30s, your hormones fluctuate throughout your cycle in a very predictable way. All changes when you begin perimenopause, which usually happens in your mid forties, but can begin in your thirties or even earlier. Most importantly, estrogen starts to drop during this phase, and not in a slow and steady way.  Estrogen jumps all over the place with lots of peaks and valleys, before settling for good at a very low level after menopause, which is the moment in time when you’ve gone 12 months without a period. Progesterone and testosterone, two other sex hormones, also decrease during this time.

All of these hormonal changes can impact migraines—both how often the intense headaches happen and how severe they feel. It’s believed that estrogen is the main culprit, since levels going higher or lower than normal are linked to a bigger risk for migraines. Exactly why they’re connected is still being researched (more on a leading theory below), which can make it frustrating for those suffering from hormone-related migraines to find relief.

Some women may experience their first-ever migraine attacks during perimenopause. Others who have had migraines for years may notice that their symptoms get worse. But there is some good news: After menopause, when hormone levels stabilize with far fewer fluctuations, many people find that their migraine symptoms lessen. 

Unlike tension headaches, which can be described as a band of pain across your forehead, migraines tend to be more severe, and often feel like:

• Throbbing and pounding
• Pain often on only one side, although it can be on both
• Pain that gets worse with activity
• Light or sound sensitivity 
• Feeling nauseous

In some cases, migraines can be accompanied by what’s known as a migraine aura. This is when you experience visual changes, like seeing sparks, or have trouble speaking before a migraine hits.

Menstrual Migraine and Hormonal Changes

If you’ve ever experienced migraine attacks around your period, then it will come as no surprise that there’s a direct connection to hormonal changes that are happening in the body. In fact, more than half of all migraines that women experience occur in the timeframe from two days before their period to three days after it begins. This is likely because of the big drops in estrogen and progesterone that occur around this time. 

Even if you’re taking birth control pills, you may notice that debilitating headaches happen most often during the last week of the pill cycle, when you take pills that don’t have any hormones in them. This can lead to a drop in estrogen, triggering the migraine. In those cases, your doctor may recommend you skip that week and only take pills that contain hormones.

Perimenopause and Migraine Symptoms

Migraines during perimenopause can be especially maddening because they may occur on both sides of the estrogen seesaw. 

• Estrogen highs can trigger a migraine with aura (visual disturbances).
• Estrogen lows, when you’re going through a sort of estrogen withdrawal, can lead to migraines without aura.

Either way, you’re still suffering through headache pain. To make matters worse, common symptoms of perimenopause, such as higher levels of anxiety and trouble sleeping, can also increase migraines.

To know if perimenopause may be triggering your migraines, you first need to know where you are in the menopause transition. Keep an eye out for common symptoms, like hot flashes, unexplained weight gain, insomnia, vaginal dryness, changes to your libido, as well as more surprising menopause symptoms, like tender breasts and dry skin. If you’re experiencing some of those symptoms along with more frequent or severe migraines, the headaches may be linked to perimenopause. This is why it’s important to speak with a menopause-trained healthcare professional, like a Midi clinician, about your symptoms. Women often wait too long to connect the dots between perimenopause and telltale symptoms, and uninformed providers are no help.

Treatment Options for Migraines During Menopause

While migraines that begin or worsen during perimenopause can be frustrating, there are a wide range of treatment options you can try.  “When hormones bottom out and plateau post menopause, migraines can improve but getting there and enduring the roller coaster of perimenopause leading up to menopause can be rough for some,” says Dr. Jordan. So be persistent until you find relief!

Hormone Replacement Therapy for Migraine Attacks

Hormone replacement therapy (HRT) works by releasing bioidentical hormones (which means they have the same chemical and molecular structure as hormones that are produced in the human body) into the bloodstream or vaginal tissue. The name is a little misleading—you’re not replacing any hormones but supplementing your estrogen levels. HRT is available in many forms, including pills, patches, vaginal rings, pellets, topical creams and gels. To protect the uterus (in patients who have one, as opposed to those who’ve undergone a hysterectomy), doctors add progesterone or progestin to estrogen, which reduces any risk of uterine cancer. You’ll also hear it referred to as hormone therapy (HT) or menopausal hormone therapy (MHT),

Can HRT help with severe headaches and migraine attacks? Research shows that starting HRT, for some patients, can trigger migraines to begin with. It can also make existing migraines worse (especially those with aura). For others, however, HRT can improve migraines during menopause. “Migraines are just one of many challenges that face women in midlife, and they can negatively impact both their professional and personal lives.  For these women, I do encourage them to talk to someone trained in the unique challenges women face in midlife and have the "Are hormones right for me?" conversation,” says Dr. Jordan 

There are a few things to keep in mind when discussing HRT with your healthcare provider as an option to help with migraines and any other menopause symptoms you’re experiencing:

• Studies suggest that women who experience migraines with aura have a higher risk of stroke. 
• Studies also suggest that the use of oral contraceptives in women who have migraine with aura can result in further increases in the risk of ischemic stroke, although the absolute risks are low.  
• However, the use of HRT, particularly in the form of an estrogen patch or cream, is not thought to increase the risk of stroke or clots in women with migraines. 

Non-Hormonal Medications

If you experience a migraine headache, there are medications, called acute treatments, that you can take as soon as symptoms begin to feel better, faster. Migraine treatments that can reduce headache pain include the following (and get ready for some tongue twisters):

• Fast-acting triptans: These medications help fix chemical imbalances in the brain that may be causing your pain. They boost levels of serotonin, which helps blood vessels constrict and improve symptoms. You can take them as a pill, dissolving tablet, nasal spray, or injection. Some options are sumatriptan, rizatriptan, and zolmitriptan, and your healthcare provider will be able to point you towards the right one for your symptoms.
• Combining triptans with NSAIDs: While nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may work on their own for some with mild symptoms, they can also be combined with a fast-acting triptan for a two-pronged treatment approach that works better than either medication does alone. 
• Ergot derivatives: These include ergotamine tartrate and dihydroergotamine and they impact the ability of pain messages to get transmitted, helping you feel better.
• Preventive medications: If you’re dealing with weekly migraines or especially bad symptoms, you can take a daily medication to cut down on frequency and severity. Current medications FDA-approved for headaches and migraines include erenumab and galcanezumab-gnlm, but there are also other kinds of drugs, such as beta-blockers and anticonvulsants, that may work. Botox injections from a headache specialist can also be helpful, if you qualify for them. 

Lifestyle Changes

When hormonal shifts set off migraines during perimenopause, it’s even more important to avoid other potential migraine triggers. Lifestyle changes like these can help:

• Eat a balanced diet: Obesity may raise your risk for headaches, so maintaining a healthy weight by choosing more nutritious foods is important. And don’t go too long between meals, since fasting can make your blood sugar dip, triggering an attack. The National Headache Foundation recommends a diet that is low in tyramine, an amino acid that can cause migraines, which includes things like cured meats, fermented foods, and aged cheeses.
• Avoid other key food triggers including: alcohol (especially fermented items like red wine and champagne), nitrites (found in cured meats), monosodium glutamate (aka MSG, a flavor enhancer in some sauces and packaged noodles), and caffeine (chocolate, coffee, tea, colas) 
• Manage your stress: Stress can raise your heart rate and blood pressure and cause your muscles to tense up, possibly triggering a migraine. Explore relaxation techniques to find what works for you. Good places to start: yoga, meditation, or an alternative therapy like acupuncture.
• Get in an exercise groove: Not only is working out great for reducing stress, it’s also linked to milder migraine symptoms and fewer attacks. You don’t need to become a marathon runner—just going on daily walks around your neighborhood can begin to make a difference.
• Prioritize sleep: While sleep can definitely take a hit during perimenopause, try to set yourself up for success by keeping what’s known as a sleep schedule—going to bed and waking up around the same time every day—and practicing good sleep habits (no screens near to bedtime, making sure your room is cool and dark).
• Keep a headache diary: People can have different migraine triggers, so noting down what you recently ate or how you felt right before a migraine started can help you see your own personal patterns. Maybe your trigger is caffeine or red wine, or only getting six hours of sleep. Once you connect the dots, you can work on avoiding those triggers in the future.

Managing Migraine Attacks

• In addition to taking medication when a migraine strikes, there are some things you can do to help get through the attack. These include:
• Resting in a quiet, dark room if you can, since migraines can make you more sensitive to light. You can even try to take a nap if your symptoms allow you to fall asleep.
• Applying cold or warm compresses to your head may help, as can pressing down with gentle pressure wherever you feel pain.
• Staying hydrated, especially if your migraine causes you to vomit. You can also try to have a little bit of caffeine, which can help some people (but can make symptoms worse in others, so experiment with care).

When to Seek Medical Help for your Migraines

Anytime you’re dealing with major pain, you should seek help, pronto. So if you’re experiencing migraines, bring it up to your healthcare professional and make sure you get advice on both medications and prevention strategies. By looping your healthcare provider in early, they will be able to monitor you for any other related condition. This matters, because migraines are more likely in people with other medical conditions, including depression, anxiety, bipolar disorder, epilepsy, and sleep disorders. And having migraines can raise your risk slightly for stroke. 

There are also certain instances where you should make an appointment or go to urgent care as soon as possible to rule out any of the more serious headache causes. These include if your migraines began after hitting your head, you also have convulsions or confusion with your migraines, or your headaches are accompanied by a stiff neck or pain in your eye or ear.

Frequently Asked Questions (FAQs)

How can I get rid of menopause migraines?

As soon as a migraine begins, treat it with a medication such as an NSAID, fast-acting triptan (if you’re a candidate), or combination of the two. You should also try to rest in a dark, quiet room and place a warm or cold compress on your head to shorten the duration of the migraine.

Are migraines linked to menopause?

Yes, migraines may be connected to menopause and perimenopause. The fluctuating hormones that are common during perimenopause can trigger migraines or make symptoms worse. Once you go through menopause, hormone levels even out and, as a result, migraines tend to improve. 

What do menopause headaches feel like?

These are migraines where one or both sides of your head have a throbbing pain and are often linked to dips in estrogen. They may also make you more sensitive to light and sound and you could feel nauseous or vomit. 

The Takeaway

You probably already know that migraines are no fun: The pain brought on by one of these intense headaches can be debilitating, and sometimes the only thing that helps is resting in a quiet, dark room. Women in midlife should be aware that changes in hormone levels during perimenopause can trigger migraines or make migraine symptoms more severe. While there are some treatments that may help—like taking hormone replacement therapy—they don’t work for everyone. That said, there are other medications like fast-acting triptans that have been shown to improve pain quickly when migraines crop up. If you’re experiencing menopause-related migraines, make sure to talk with a Midi clinician, or another healthcare provider who understands the hormone-migraine connection, to get the help you need.