Perimenopausal Migraines: What You Need to Know

Hormonal fluctuations can have a big impact on migraines. Here's the good, the bad, and how to deal.

by The North American Menopause Society
migraine headache woman picture
Photograph: Marcela Barsse

Migraine headaches are painful and can put your life on hold for several hours or days. They’re often connected to fluctuations in estrogen—and women make up 70 percent of the 28 million Americans who suffer from migraines.

Every woman is different so menopause can affect your migraines in a number of ways. Menopause may make migraines less severe if they were linked to the hormonal fluctuations of your menstrual cycle. Or migraines may start for the first time, or worsen, around perimenopause because of new hormonal fluctuations. Hormone therapy for menopausal symptoms may also be linked to migraines at this time. The good news is that hormonal migraines usually stop after menopause, when hormone levels are consistently low.

Migraines are often misunderstood, underdiagnosed, and inappropriately treated, so here’s what you need to know about their causes and possible therapies:

What is a migraine?

Typically, migraines cause a moderate-to-severe throbbing pain that is worse on one side of the head, and is usually aggravated by physical activity. Other symptoms, such as nausea, vomiting, and sensitivity to light and noise, are common. Migraines usually last 4 to 72 hours and may occur rarely or up to several times a week.
There are two types of migraine headaches: those with aura and those without aura.
Migraine with aura. A woman may have some of the following sensory symptoms (the “aura”) before a migraine begins:

  • Seeing flashing lights and floating lines, or developing temporary peripheral blindness
  • Numbness or tingling in the face or hands
  • Distorted sense of smell, taste, or touch
  • Mental confusion

Migraine without aura. A woman will have all the other features of a migraine but will not have the sensory symptoms beforehand.

What causes migraines?

The causes of migraines are not fully understood, but researchers think that they are caused by changes in levels of brain chemicals. These changes can cause inflammation, which makes blood vessels swell and press on nearby nerves, causing a migraine. Some evidence suggests that these hormonal migraines may ultimately be related to changes in the amount of serotonin in the brain.

Genetics also have been linked to migraine, so you are more likely to have migraines if they run in your family.

Women who suffer from migraines react to a variety of factors called “triggers.” These triggers can vary from person to person and don’t always lead to migraine, including:

  • Bright or flashing lights
  • Lack of food or sleep
  • Stress
  • Changes in hormones and hormonal levels (such as menstrual periods, pregnancy, and perimenopause)

A combination of triggers is more likely to set off a migraine. A useful tool in managing your migraines is to keep a diary of when they occur to help identify your triggers and any relation to your menstrual cycle or hot flashes.

How are migraines treated?

Treatments without medication include biofeedback, relaxation techniques, changes in diet, stress reduction, acupuncture, and regular sleep/wake schedules.

Medications can prevent migraines from occurring (magnesium, aspirin, triptans, ergots, and hormone therapy) or stop a migraine that has already begun (triptans and nonsteroidal anti-inflammatory drugs).

Note that hormone therapy affects each woman differently. Some will have a reduction in migraines, while others might have worse symptoms. In some women, taking birth control pills during perimenopause may provide both contraception and relief from hot flashes and migraine. If you have menstrual migraines during perimenopause, you may want to use a low-dose estrogen on days surrounding your period as a preventive measure (this may be not be possible if your period is unpredictable, as it often is during perimenopause).  The goal for hormonal treatment is to stabilize estrogen levels.

First Published February 28, 2012

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