Are migraines linked to menopause?
Menopause migraines
Migraine affects more women (43%) than men (18%). They particularly affect women who are still having periods, with migraines being triggered in the days before and during a period.
Migraines may improve after menopause. On the flip side, they may also get worse in perimenopause.
We look at the role of fluctuating hormones in menopause and the link with migraines.
How do hormones affect migraine in menopause?
Migraine usually occurs after a girl starts having her periods - it happens more during her period, and often improves during pregnancy and after menopause.
There’s a strong link between sex hormones and migraine and menopause can affect migraines in different ways.
For a woman whose migraines were previously linked to fluctuating hormones in their menstrual cycle, they can become less severe. Or for some, they may be experienced for the first time, as hormones, particularly oestrogen, alter in perimenopause.
Perimenopause periods and migraines
More frequent, heavy, painful periods and the heavy bleeding that happens in perimenopause when the normal hormone cycle is disrupted, can make migraine more likely. But as periods decline, so the hormonal trigger for migraine declines, which is why many women find migraine improves after menopause.
Other menopause symptoms such as hot flushes and night sweats can disrupt sleep, increase stress levels and raise the possibility of a migraine.
Although evidence suggests that migraine and hormones are connected, there have been few studies that have looked at migraine and menopause status.
A 2015 study published in the International Journal of Women’s Health acknowledged the role of oestrogen but also suggested a link between changes in levels of serotonin, (Oestrogen plays a role in serotonin production) and the connection with vasomotor symptoms, i.e. those hot flushes.
Whatever the hormonal cause, migraines are often misunderstood, underdiagnosed, and incorrectly treated.
What is the difference between a headache and a migraine?
‘A migraine is usually a moderate or severe headache felt as a throbbing pain on 1 side of the head. Many people also have symptoms such as feeling sick, being sick and increased sensitivity to light or sound’. (www.nhs.uk)
The National Migraine* Trust say that ‘headaches’ are not usually accompanied by symptoms associated with migraine, as outlined above. It is quite likely that if you have a migraine, you will also experience other headaches.
What triggers menopause migraine?
A combination of triggers may bring on a migraine, including:
Hunger, low blood sugar levels, or certain food and drinks
Stress
Tiredness and fatigue
Changes in hormones and hormonal levels - periods, pregnancy & perimenopause
Hot flushes or night sweats
How to manage hormonal perimenopause migraines?
Keeping a diary over a period of at least three months will help you to identify triggers - when migraines occur, what you’d eaten or drunk, whether you were having a period, hot flushes, sleeping badly etc. You can show this to your doctor when looking for help with managing migraines in menopause.
Natural treatments include:
Relaxation techniques
Balanced diet & eating schedule
Stress management
Acupuncture
A healthy and regular sleep pattern
Biofeedback therapy - helps control muscle tension to reduce the intensity of migraines
Supplements and herbs: Feverfew, Magnesium, Vitamin B2. The Migraine Trust has detailed information and studies.
Medication that may help prevent migraines, include:
Magnesium
Aspirin
Triptans
HRT (helps remove some contributory menopause factors rather than the migraine – see below)
Medication to take once a migraine has already begun
Triptans
Nonsteroidal anti-inflammatory drugs
Does HRT help with migraines?
Migraine is more likely to occur when hot flushes and night sweats are experienced.
HRT can help to manage these symptoms potentially reducing the number of migraines. However, some forms of HRT, particularly in tablet form, may trigger migraine.
Topical oestrogen applied as a patch or gel provides more stable levels of hormones and may be beneficial for women experiencing migraine.
Once HRT treatment starts, the Migraine Trust recommend trying it for three months as the body finds its’ balance.
If you need HRT for menopausal symptoms but develop headaches as a result, managing your headaches may be a little difficult, working with your doctor to find the right dose and hormone balance.
The hormonal cycle can continue for some years after your last period. Changing hormone levels may not result in a bleed but may still trigger migraine.
The cycle will eventually come to an end, so migraine attacks should settle within 2 to 5 years post-menopause.
Although some women continue to have regular attacks after their menopause, for most the end of natural menopause can be a time of significant improvement in migraine. At least that’s a positive for menopause!
September 2021
