Ask anyone who suffers from migraine headaches and they will tell you in no uncertain terms that this is not “just another headache.” Migraine is actually a complex central nervous system disorder and is characterized by long duration headaches (from 4 to 72 hours if untreated) often on only one side of the head and is usually accompanied by sensitivity to both light and sound as well as nausea and vomiting. Family history, age, and a variety of factors can contribute to the likelihood of getting migraines for both women and men but it’s women who will often notice a connection between hormonal changes and headaches.

Although migraines can begin at any age, they typically make their first appearance during adolescence. For both men and women, migraines tend to peak when people are in their 30’s and then in general become less severe as people get older. Research suggests that migraines are heavily influenced by hormonal fluctuations, so it’s no surprise that women are three times as likely as men to suffer from migraines. Many women who have migraines will report having them just before or during their period.

But what about menopause? What is the connection between migraines and menopause?

Many clinicians have long held the opinion that migraines improve during menopause. But according to a 2020 study published in the journal Women’s Midlife Health, current studies have not done an adequate job of looking at migraine prevalence during particular stages of the menopausal transition. According to this study, which re-examined the impact of migraines on midlife women, migraines typically improve after menopause. Due to fluctuations in estrogen levels, the perimenopausal period is associated with a significant worsening of both symptoms and frequency of migraine headaches.

Plus, this study makes clear there are still many unanswered questions such as how does a history of having migraines associated with their period predict how these same women will react during the transition to menopause. And the research is still not clear on how discontinuing the use of hormone replacement therapy might impact women with migraines, given that there are several subtypes of migraine which may all influence a women’s experience differently. Women who are experiencing the onset or increase in migraine headaches during the perimenopausal period can expect treatment challenges, as fluctuations in hormones that bring on attacks are unpredictable.

Each woman is an individual and will react differently to treatment options. In some women, taking hormone replacement therapy can actually worsen headaches, while in other women headaches improve or may cause no change at all. For women who are already taking hormone replacement therapy but are still suffering from migraines, some clinicians will prescribe a skin patch that contains estrogen. The patch will deliver a steady, low-level supply of the hormone and this is less likely to make your headaches worse. For women whose hormone replacement therapy makes their headaches worse, their doctor may choose to lower the dose of estrogen or switch to a different estrogen form. Some women, in consultation with their physicians, choose to stop hormone replacement therapy altogether.

In addition to hormone therapy adjustments, your doctor will also likely prescribe a combination of medications designed to prevent headaches from starting along with medications to relieve the headache once it has begun. Sometimes, simple lifestyle changes can also help, such as keeping a diary of foods that may trigger your migraines, such as chocolate, aged cheese, or artificial sweeteners. Sleep is very important, so do your best to go to bed and get up at the same time each night and day, eat your meals at regular times to avoid dips in blood sugar, and implement a program of stress control, such as guided relaxation or meditation.