How Does Menopause Affect Migraine?

As you approach menopause, your experience with migraine may change. Here’s when menopausal migraine changes may happen, and what these changes can mean for you.

Menopause is a completely natural part of getting older. But just because something is natural doesn’t mean it’s always comfortable.

As you go through menopause, your body experiences major biological shifts driven largely by changes in hormone production. For many people, these hormonal changes are often accompanied by symptoms ranging anywhere from frustrating to unbearable.

Change in migraine and headache patterns is one such symptom. For some people going through menopause, migraine attacks can increase in frequency and severity — or migraine episodes may even start to occur for the first time.

Here’s why menopause can affect migraine, what that means for you, and some ways to find relief from menopausal migraine changes.

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What is menopause?

First, it’s helpful to understand what, exactly, menopause is.

Menopause is defined as the period of time starting 12 months after your last menstrual period. This point in life marks the end of menstrual cycles and reproductive years for people assigned female at birth (AFAB). It’s important to note that menopause does not only affect cisgender women. Trans men and nonbinary people may also go through menopause.

Menopause is preceded by a transitional period known as “perimenopause,” when your body begins experiencing biological shifts and hormonal changes in preparation for menopause. Perimenopause can last anywhere from a couple of years to a decade and usually begins in a person’s late 30s or early 40s.

Then, once you’ve gone 12 consecutive months without a period or spotting, menopause is officially diagnosed. Most people reach menopause in their 40s or 50s, with 51 being the average age of menopause in the US.

Changes in your body’s hormone production, namely reproductive hormones like estrogen and progesterone, drive perimenopause and menopause. As you approach menopause, reproductive hormone levels fluctuate and decrease over time, and this volatility can cause any number of symptoms.

How does menopause affect migraine?

So, how does menopause impact migraine? Well, it comes down to hormones.

To understand the interaction between migraine and hormones, let’s take a look at premenopause migraine first.

If you menstruate, you may have already experienced menstrual migraine. These are migraine episodes you get around the time of your period. More specifically, menstrual migraine generally occurs anywhere from about 2 days before your period starts to about the third day of bleeding.

Hormone-wise, this stage of your menstrual cycle corresponds to a drop in estrogen, which is at its lowest levels during your period. It’s precisely these low estrogen levels that are thought to be the main cause behind menstrual migraine.

In fact, decades of research have repeatedly shown that estrogen is linked to migraine. And out of all headache types, migraine is the most affected by estrogen.

Now, back to menopause. This stage in life is marked by significant fluctuations in estrogen levels (during perimenopause), followed by a dramatic decrease overall (at menopause).

Postmenopause, the ovaries — which are the main source of estrogen before menopause — produce almost no estrogen at all. You can think of menopause as a kind of natural estrogen deficiency.

The result of these fluctuating and declining estrogen levels around menopause? A potential increase in migraine frequency and severity.

Put concretely: you may experience more frequent and worse migraine episodes as you go through menopause. You’ll largely have the same types of symptoms as you did before menopause, but they may be more severe.

People who experience menstrual migraine during their reproductive years may be more susceptible to worsening menopausal migraine.

It’s even possible for people who never dealt with chronic migraine or headache pain before menopause to have an onset of migraine around menopause.

What’s the timeline for menopausal changes in migraine?

For many people, symptoms that we commonly think of as “menopausal,” including worsening headaches and migraine, actually begin during perimenopause.

A 2016 study, for example, looked at high frequency headaches (defined by the study as 10 or more headache days per month) in migraineurs transitioning into menopause. The study found an increased risk of high frequency headache during perimenopause as compared to premenopause.

In other words, if you haven’t reached menopause but you’re already experiencing more frequent and severe migraine, perimenopause may well be the reason — particularly if you’re in your late 30s or early 40s.

Reaching official menopause (12 consecutive months after your final period) may actually bring relief for some migraineurs, as estrogen and other hormone levels stabilize following years of perimenopausal fluctuation.

Research suggests that those who predominantly have migraine without aura experience improvement in migraine frequency and severity following menopause.

For those who have migraine with aura, however, improvement after menopause is less common.

How to treat menopausal changes in migraine

Maybe you want immediate perimenopausal or menopausal migraine relief. Maybe you’ve reached menopause, and your migraine hasn’t improved. Whatever the case may be, treatment options adapted to your changing body are available to you.

Depending on your particular situation, certain migraine treatment options you may have used before menopause remain an option, including:

• oral medications, like triptans and over-the-counter pain relievers (ibuprofen, acetaminophen, naproxen, etc.)
• nasal spray forms of certain oral medications, like triptans
• injectable medications, like sumatriptan or calcitonin gene-related peptide (CGRP) inhibitors in injectable forms
• vitamins and supplements that may offer relief, like magnesium and coenzyme Q10
• lifestyle changes, like reducing stress, eating regular meals, getting enough sleep, and exercising regularly

For perimenopausal and menopausal people, in particular, certain hormonal medications may offer relief from worsening migraine. These include:

• Hormone therapies (HT), like estrogen replacement therapy or combination estrogen and progesterone replacement therapy
• Transdermal estrogen, delivered through patches, gels, or sprays

Hormone therapies aim to treat menopausal symptoms by supplementing and stabilizing hormone levels and may help alleviate migraine frequency and intensity. To avoid fluctuating hormones that risk triggering migraine, the North American Menopause Society recommends continuous HT treatment rather than cyclic treatment.

Transdermal estrogen treatments similarly seek to stabilize estrogen levels by providing low and steady doses of this hormone. This form of medication may also help relieve migraine episodes, lowering their frequency and severity.

Keep in mind that, just like before menopause, each person reacts differently to different treatments: what works for one person may not work for you. This is also the case with hormone therapies.

HT may improve migraine for some people, while worsening the condition for others. Some menopausal people with a history of migraine, particularly menstrual migraine, may be more sensitive to the increases in estrogen from HT. In some cases, HT may even trigger migraine attacks in people who didn’t have migraine premenopause.

For menopausal people with migraine with aura, hormonal treatments containing estrogen may not be a safe option due to the possible increased risk of certain medical conditions, like stroke. Transdermal estrogen treatments may be safer, but more research is needed.

If you try any kind of hormonal treatment options for menopausal migraine, be sure to keep your doctor in the loop so they can adjust your hormone dosage as needed according to your reactions.

The takeaway

As you approach menopause, your experience with migraine may change. You may find that you have migraine episodes more often, or that your migraine symptoms worsen. These menopausal changes in migraine are related to your fluctuating and decreasing hormone levels — estrogen, in particular.

For some people, worsening migraine symptoms may be confined largely to the perimenopausal period and may improve after reaching menopause. For others, this may not be the case.

Either way, many treatment options may help relieve migraine symptoms throughout the transition into menopause. Consider talking with your doctor as you approach or begin perimenopause to understand your options for addressing any changes in migraine that may occur.

As always, keep your doctor informed about changing migraine symptoms and any reactions to your treatment regimen.