If you’re in your 40s, 50s, or early 60s, you may have assumed your migraine attacks would fade away by now, like that annoying coworker who eventually finds another job. Instead, it seems to be getting worse. Hormone changes during perimenopause and menopause don’t help either. And when you’re juggling a job, family demands, and other responsibilities, checking out for days isn’t an option. So you’re left wondering: What do other women actually do to stop migraine from affecting their lives?
“I always start by reminding my patients that migraine is a neurological disease that’s in their DNA and is not due to something they’re doing wrong,” says Jessica Kiarashi, MD, a neurologist at UT Southwestern Medical Center. And drops in estrogen during perimenopause and menopause can make attacks worse, says Ella Akkerman, MD, a neurologist at Virginia Spine Institute (VSI).
Kiarashi, Akkerman, and Emily Kostelnik, a clinical health psychologist specializing in neurological conditions who also lives with vestibular migraine, all agree that the factors that make migraine worse are highly individual. There’s no one-size-fits-all solution. But seeing what helps other women your age can give you clues to what might work for you.
We asked women in midlife who live with migraine how they manage — and checked what our experts had to say.
Know Your Triggers
Cathy Rust battled migraine for a decade during perimenopause. “It was horrific,” she says. The attacks escalated despite trying every professional suggestion—Botox, beta blockers, acupuncture, progesterone, meditation, even cognitive behavioral therapy. Then her doctor advised keeping a migraine journal to identify triggers, and Cathy got to work.
“I researched common triggers and then noted in a journal my activities and food and beverage intake,” she says. “Then, I started eliminating things to see if it made a difference.” Pretty soon, the pattern became clear. “My triggers were alcohol (especially red wine), gluten, dairy, and the worst and most depressing trigger was exercise.”
After six months of strict avoidance, her migraine attacks decreased significantly. “Now I rarely get one,” she says, noting that she can no longer eat gluten.
Kiarashi and Akkerman agree that this kind of detective work is very helpful. “This is what I always tell patients to do,” Kiarashi says. She suggests keeping a migraine diary for three to six months, as this will let you see patterns emerge.
You can go old-school, with a notebook and pen, or you might prefer a digital solution. “These days, migraine specific apps, many of them free, such as Migraine Buddy, can help with keeping track of migraines and their triggers,” Akkerman says.
While there are no universal food triggers for migraine, some common migraine triggers include alcohol and stimulants such as coffee and monosodium glutamate (MSG), Kostelnik says. Elimination diets, such as low-histamine or low-tyramine diets, can be helpful for some, she says, “but should always be done under the supervision of a dietitian, especially for those with a history of anxiety, perfectionism, or eating disorders.”
Consider Taking Magnesium and Riboflavin Supplements
Carla Feuer is 62 and has lived with painful migraine attacks since high school. After pregnancy, the attacks shifted into visual auras and more recently into vestibular migraine.
Today, things look different. “I only experience occasional aural episodes...a huge improvement,” Carla says. “What made the difference for me was an over-the-counter supplement called MigreLief, which my neurologist suggested when I hesitated to try pharmaceuticals due to their side effects.” MigreLief combines magnesium, riboflavin (vitamin B2), and Puracol Feverfew, a plant extract.
Carla’s experience shows that supplements can sometimes be helpful. The two natural supplements with the most consistent evidence are magnesium and riboflavin, Kiarashi says. Magnesium doesn’t just relax muscles; it also helps block pain and inflammatory chemicals in the brain and relaxes muscles, both of which can help prevent migraine, Akkerman says.
Kiarashi typically recommends magnesium glycinate because it’s gentler on the stomach compared to other forms of magnesium, such as magnesium oxide. A typical dose is 400-500 mg per day. The suggested dose of riboflavin is usually 200 mg twice daily, and the only downside is that it turns your urine bright orange, she says.
Feverfew and coenzyme Q10 are also worth considering, Akkerman says. Feverfew is usually taken at 100-300 mg per day and coenzyme Q10 at 300 mg daily.
Stay Hydrated and Check Your Electrolyte Levels
Sometimes, the simplest changes — such as drinking more water — can make a big difference.
For 47-year-old Jennifer Armendariz, staying hydrated is an important part of her migraine prevention routine. “I aim to drink about two to three liters a day, and I make sure I’ve had at least one glass of water before I drink my morning coffee,” she says.
Shanna Bynes Bradford took her hydration routine a step further. At 49, with a very active lifestyle, she was puzzled by the migraine attacks hitting her every three to four days. “Then I had my electrolyte levels tested, and it came back that my sodium levels were low,” she says. Acting on that insight, she began adding a pinch of kosher Celtic sea salt to her spring water — once in the morning on an empty stomach and again at night before bed. “I started this routine about three months ago, and I haven’t had a migraine flare-up since.”
Jennifer and Shanna’s experiences aren’t unusual. Dehydration is a very common migraine trigger, Akkerman says. Women generally need 10-12 cups of fluids daily, which comes out to about two to three liters. “This does not have to be water but can include coffee or tea, soups, smoothies, or high water content fruits and vegetables.”
Electrolyte balance matters, too. “Hydration is crucial, though some individuals benefit from adding electrolytes rather than drinking plain water alone,” Kostelnik says.
Get Consistent, Good Quality Sleep
For Adriana Green, “sleep is the foundation” of her migraine management routine. “I’m 47 and have lived with episodic migraines for much of my adult life,” she says. Over the years, Adriana developed a daily rhythm that helps her reduce both their frequency and intensity. “I keep a consistent bedtime and wake-up time — even on weekends — and avoid screens at night to support better rest.”
Experts agree that Adriana is doing the right thing by keeping a consistent sleep schedule. During sleep, the brain resets itself. With inadequate or disrupted sleep, your brain’s chemical balance gets thrown off, which lowers your ability to handle pain and causes nerve inflammation that triggers migraine, Akkerman says.
Too little sleep can trigger a migraine, but even oversleeping — such as “catching up lost sleep” during the weekend — can also trigger attacks, Kiarashi says; so sticking to a sleep routine really matters.
Getting good quality sleep can be a challenge when you’re going through menopause. Avoiding screens at night, as Adriana does, is a good habit because bright light before bed can confuse the brain and make it harder to fall asleep, Akkerman says.
To support better sleep, Kostelnik also recommends that you get morning light exposure (without sunglasses, if you can tolerate it), avoid caffeine after midday, sleep in a cool, dark room, and reserve your bed for sleep and intimacy only.
For those with trouble falling asleep, short-term use of melatonin (about 4 mg, taken one or two hours before bedtime) may help, Akkerman says. But she doesn’t recommend using melatonin for longer than one or two months and suggests talking to a doctor if you have persistent insomnia.
Find Your Stress Release Valve
For 50-year-old Celine Vignal, learning to manage stress was a turning point after 25 years of migraine. “The need came during a particularly stressful period when my body was constantly tense, I was depressed, and my chronic migraine flares were very intense,” Celine says. “I knew I needed a proactive way to address both the physical and mental toll, and I didn’t want to pile up on meds due to the long-term side effects.”
That realization led her to develop a daily breathwork routine. “Each morning, before even checking emails, I dedicate 10-15 minutes to seesaw breathwork sessions,” she says. The sessions consist of slow, rhythmic breathing — about six breaths per minute — that helps calm her body and mind. “Throughout the day, if I feel a flare-up coming, I start a new session.”
Other women find stress relief through movement helps to keep their migraine attacks under control. Jennifer Armendariz swears by her workouts to release stress: “I exercise four to five times a week with strength training and cardio. I also incorporate lots of stretching and yoga.” Adriana Green prefers gentler rhythms: “I walk outside daily and practice restorative yoga a few evenings each week. I take small breaks to stretch, step outside, or simply breathe.”
What Celine, Jennifer, and Adriana are doing, each in their own way, is taking care of their nervous system. “The nervous system is often overlooked because it feels abstract,” Kostelnik says, “but it is just as important as nutrition or exercise.”
“Stress management is essential for migraine prevention,” Akkerman says. Chronic stress lowers happy chemicals in the brain, including serotonin and dopamine, which leads to a lower pain threshold and increased neuroinflammation that triggers migraines.” She recommends using apps for meditation, relaxation, and stress management.
Because of its myriad effects on the body, regular exercise can be a powerful tool for women with migraine, Akkerman says. You don’t have to train like an athlete to see results. “As little as 30 minutes of raising heart rate above 120 beats per minute three times a week can make a difference.” Gentle movement, such as walking, yoga, and stretching, helps too. “They decrease muscle tension and stress hormones that are linked to triggering migraines.”
But she cautioned against pushing too hard. “Overstraining can cause injury or muscle tension which can trigger a migraine, especially if pain is located in the neck or shoulder region.” And if you notice exercise itself brings on your migraine, talk to your doctor — it could be related to dehydration, low blood sugar, or blood pressure changes.
As the women in these stories prove, finding small things that help and incorporating them into your daily routine can really make a difference. “My routine isn’t perfect, but it has helped me experience fewer migraine flares and recover more quickly when they do occur,” Adriana says.
