Migraine is a type of severe headache that might also cause other symptoms, such as nausea and light sensitivity. It may improve or worsen during menopause.

Migraine is more common in menstruating people of reproductive age, but it may get worse in perimenopause, which is the period before menopause.

A potential connection between migraine and menopause is that headaches may improve after menopause. However, they may also get worse.

In this article, learn more about this link and why it might exist. This article also provides more information about menopause and how to alleviate migraine symptoms.

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Migraine is more common in people of childbearing age. For many people with migraine, the days before and during a period are significant migraine triggers.

One article in the journal Therapeutic Advances in Neurological Disorders cites a 71% increase in the risk of having a migraine in the 2 days leading up to a period.

During the menstrual cycle, estrogen levels drop right before a period starts. This estrogen withdrawal may trigger migraine without an aura. An aura is a group of symptoms such as flashing lights that sometimes appear before a migraine.

High levels of estrogen, which are common leading up to ovulation, may also trigger migraine with aura.

Most population-level studies, which are studies that look at an entire population, show that migraine headaches tend to improve after menopause. This may be because a person no longer experiences the hormone shifts that once triggered their migraine pain.

Headaches may temporarily get worse during perimenopause, which is the period leading up to menopause during which a person is likely to experience other symptoms, such as hot flashes.

However, studies that look specifically at people seeking treatment at headache centers — a subset of people who may have especially severe migraine — suggest that migraine may actually get worse during menopause.

There is no way to predict how menopause will affect someone’s migraine pattern. A change in migraine pattern leading up to menopause may occur because of shifting hormone levels.

Menopause marks the end of a person’s ability to get pregnant. Doctors define it as a period of 12 months without menstrual cycles.

The median age of menopause is 51 years, but it may begin as early as age 40 years or as late as during a person’s 60s. In some people, premature menopause in their 20s or 30s causes infertility.

Perimenopause is the time leading up to menopause. During this time, a person’s periods may become more irregular. They may also experience a wide range of symptoms, including:

  • hot flashes
  • night sweats
  • heart palpitations
  • painful sex
  • vaginal dryness
  • mood changes, such as irritability, anxiety, and depression
  • weight gain
  • increased blood pressure

Many classic menopause symptoms, such as hot flashes and night sweats, go away after perimenopause. However, some — such as vaginal dryness — may linger because of lower estrogen levels.

Menopause may ease migraine headaches, cause them to get worse, or trigger no changes at all. For people whose menstrual cycles trigger migraine, migraine may improve once those end.

A 2016 study compared premenopausal, perimenopausal, and postmenopausal headache rates among people with a history of migraine. The researchers defined a high headache rate as having 10 or more headaches per month.

They found that:

  • among premenopausal participants, 8% had a high headache rate
  • among perimenopausal participants, 12.2% had a high headache rate
  • among postmenopausal participants, 12% had a high headache rate

This suggests that the transition to menopause is often a trigger for more frequent headaches in people with a history of migraine.

Hormone replacement therapy may actually make menopausal migraine worse, especially when it causes fluctuating hormone levels. A 2007 study found higher rates of headaches, including migraine headaches, among people taking hormones after menopause.

Not all research supports this claim, however. Some earlier studies did find that hormone replacement therapy could ease migraine symptoms. So, a person may need to be willing to try various treatments and monitor their effects.

Some people may choose hormone therapy to manage other menopause symptoms, such as hot flashes and vaginal dryness. Low-dose treatments are less likely to trigger migraine.

A 2017 research article recommends continuous hormone therapy to reduce the risk of hormonal shifts that may trigger migraine.

A wide range of treatments can help with migraine, but no single treatment works for everyone. For this reason, a person may need to experiment with various remedies and keep a headache log to monitor any improvements.

Some options include:

Pain medications

This includes medications such as nonsteroidal anti-inflammatory drugs, which a person can buy over the counter, and prescription pain medications. These medications may offer immediate migraine relief.

Migraine abortives

These are drugs that stop or lessen the severity of acute migraine episodes. They include medications such as triptans.

Migraine prevention drugs

A wide range of drugs may help prevent or reduce the frequency of migraine episodes. Topiramate is a drug approved to treat migraine, but it has some notable side effects. Other drugs — including antidepressants, beta-blockers, calcium channel blockers, and anti-seizure drugs — may also help.

A new class of migraine drugs called anti-CGRPs are formulated specifically for the prevention of migraine.

Transcranial magnetic stimulation

This type of brain stimulation may help reduce the frequency of headaches or ease the symptoms when migraine occurs.

Alternative treatments

The herb butterbur, complementary interventions such as acupuncture, biofeedback, relaxation exercises, and deep breathing help some people.

Lifestyle changes

Getting more frequent exercise, managing stress, and monitoring and avoiding migraine triggers can offer relief. However, it can be difficult for people with migraine to undertake some of these activities when experiencing painful episodes.

Hormone replacement therapy

Hormone replacement therapy can help ease menopause symptoms. Research into its role in headaches has produced mixed results, though more recent studies suggest that it may make them worse. A person should talk with a doctor about the risks and benefits of this option.

Menopause is not a medical condition, and a person does not need to see a doctor solely because they are going through it.

Instead, a person should see a doctor if:

  • Their migraine condition has stopped or improved, and they would like to stop taking migraine medications.
  • Their migraine headaches change or get worse during menopause or perimenopause.
  • They do not get relief from migraine medications.
  • They would like to try hormone replacement therapy.
  • They began menopause very early, before the age of 40 years, or their periods suddenly stopped without explanation.

Migraine is an unpredictable neurological condition, and it may get better or worse as a person transitions through menopause.

Although it can be difficult to treat, a person does not have to live with migraine forever. The right combination of medications and lifestyle changes can ease the symptoms, so people should try to contact a doctor who takes their symptoms seriously and specializes in migraine.