Migraines in perimenopause

Migraines in Perimenopause

Many women experience an increase in migraines in perimenopause, the transitional period leading up to menopause characterized by hormonal fluctuations. Studies have consistently shown a link between these hormonal changes, particularly the decline in estrogen levels, and the exacerbation of migraine headaches.

What Is A Migraine?

Migraines often manifest with symptoms such as throbbing pain on one side of the head, nausea, and sensitivity to light and sound. These types of headaches can be quite severe. These symptoms can be triggered or exacerbated by hormonal changes. Studies show that the frequency of migraines may also increase during perimenopause.

Some people also experience what is called migraine with aura. These sensory changes precede a migraines or can sometimes happen on their own. Aura is described as changes to your vision, such as seeing zigzag lines or flashing lights.

Other Types of Headaches

Tension headaches are typically described as a feeling of a tight band around the head with a dull, aching pain diffusing throughout. They are the most common kind of headache and are linked to stress. According to The Menopause Society, most women report that these headaches remain stable or mildly worsen during the menopausal transition.

Cluster headaches are comparatively rare. They are characterized by intense stabbing pain usually around one eye, with associated symptoms like eyelid drooping, tearing, and nasal congestion. These headaches occur in clusters over a period of time followed by remission. More research is needed to understand why they occur and whether their intensity and frequency is impacted by perimenopause.

What Causes Migraines in Perimenopause?

During perimenopause women may experience the onset of headaches or an increase in frequency. Migraines in particular, tend to be more prevalent and severe during this time. Estrogen levels, which fluctuate during perimenopause, are linked to the occurrence of migraines. A decrease in estrogen just before menstruation if often a trigger, but rising estrogen can also impact migraines in perimenopause. Because estrogen levels fluctuate dramatically during perimenopause, migraines can change in terms of frequency, duration, and intensity.

A number of other factors can also contribute to headaches in perimenopause:

Not only are these risk factors for headaches, some of these are also common symptoms of perimenopause.

Interestingly, if you suffer from migraines you are more likely to develop hot flashes and night sweats as you approach menopause. These vasomotor symptoms can occur simultaneously with migraines.

Women suffering with migraines in perimenopause should consult their healthcare providers to create a management plan that addresses the unique challenges of this life stage. Understanding personal triggers and the impacts of hormonal changes is essential for effective migraine management during perimenopause.

Management and Treatment Strategies

Effective management of headaches and migraines during perimenopause can improve quality of life. The following strategies focus on lifestyle adjustments and pharmacological interventions tailored to meet individual needs.

Lifestyle Modifications

Lifestyle choices play a critical role in managing migraines in perimenopause. Consistent sleep patterns and stress reduction techniques such as meditation and yoga have been shown to help. Dietary changes, such as the exclusion of known food triggers, are also recommended. For some women caffeine can help manage migraines. But for others caffeine can be a trigger. Additionally, regular aerobic exercise can reduce both the frequency and severity of migraine attacks. It’s also important to stay hydrated.

Medications and Supplements

The pharmacological approach to treating migraines in perimenopause may include both over-the-counter (OTC) and prescription medications. OTC pain relievers like ibuprofen or acetaminophen can be effective for mild migraines. For more severe migraine pain, triptans are commonly prescribed. These block the pain pathways in the brain and can be taken as pills, shots, or nasal sprays. There are a variety of other prescription option that may be considered in the context of your symptoms and medial history.

Some may benefit from preventative medications if they suffer from frequent and long-lasting migraines that don’t respond well to treatment. These preventative options include:

  • Blood pressure medications
  • Antidepressants
  • Botox injections
  • Acupuncture

Birth control pills may be considered for migraines in perimenopause that are triggered by the hormonal ebbs and flows of your menstrual cycle. Hormone therapy may also be considered, particularly if other symptoms, like hot flashes and night sweats are present. Results of hormone interventions on migraines in perimenopause are mixed. For some hormonal options relieve migraines, for others this type of medication can make symptoms worse.

Supplemental treatments, such as magnesium, vitamin B2, and Coenzyme Q10 have been reported to reduce migraine frequency, however their studied results have been mixed. As with any medication, any supplement strategy should be discussed with your healthcare provider to ensure you understand the benefits and risks.

When to Seek Medical Advice

First and foremost, don’t suffer. If you are experiencing recurring headaches seek medical attention. One of the best things you can do is to track your headaches, including symptoms, timing, and potential triggers e.g. they happen right before your period, during times of high stress, etc. This will help you and your medical provider understand potential causes and help create a tailored treatment plan.

Individuals experiencing migraines in perimenopause should monitor their symptoms closely. If headaches become more frequent, severe, or change in pattern, medical advice is essential. One should particularly note if their headaches are accompanied by new types of aura, or if they experience a headache that feels unlike any other they’ve previously had.

According to The Menopause Society, the following symptoms require medical attention:

  • Occurrence of a “first or worst” headache
  • Progressively worsening headache
  • Sudden or abrupt headache onset
  • Headache that wakes you up from sleep
  • Headache that occurs with a high fever or rash
  • Confusion, dizziness, or weakness with a headache
  • Headache that accompanies unexplained weight loss
  • Headache that differs from all previous headaches

For those with a known migraine diagnosis, changes in the nature or frequency of migraines in perimenopause are an important topic to discuss with a healthcare provider. Treatment options may differ in the presence of other perimenopausal symptoms.

Persistent or worsening headaches or migraines in perimenopause should not be ignored, as they can impact daily function and quality of life. If treatment regimens that previously managed headaches well are no longer effective, or if the side effects of medication present new concerns, it is important to have a thorough medical review.


The intent of this information is to provide the reader with knowledge to support more efficient and effective communication with their medical providers. This information is not intended as medical advice.