Hormone Therapy: Is It the Magic Bullet for Migraine and Menopause?

Written by Sadiya Ansari
Medically Reviewed by Shruthi N, MD on October 20, 2025
8 min read

Migraine can be far more than a headache — an attack can come with warning signs such as vision problems and difficulty speaking. A migraine flare can last anywhere from two hours to three days. Women are three times more likely than men to have migraine, and up to 25% of women have migraine before their period.

But what comes next? The start of menopause comes with many other symptoms, such as hot flashes and anxiety. As your body makes less of the hormones that lead to menstrual migraine, you might expect them to fade as you enter this new phase. Instead, some women keep experiencing migraine, and sometimes, their attacks are worse than before. So why does migraine continue into perimenopause?

The good news is that hormone replacement therapy (or HRT) can help some women have fewer migraine attacks during menopause. While it isn't a direct treatment for migraine, hormone therapy can ease menopausal symptoms to help you have fewer migraine flare-ups during this new stage of life.

First, it's helpful to understand the difference between perimenopause and menopause:

  • Perimenopause is when your body's estrogen levels first begin to drop, and you start seeing symptoms such as irregular periods and hot flashes. This phase can last anywhere from a few months to 10 years. 

  • Menopause is when you haven’t had a period for 12 months. For most people, this happens between the ages of 45 and 55.

The relationship between migraine and menopause

If you experience migraine attacks like clockwork around your period, they are likely related to hormonal fluctuations. "That's somebody that we would define as having a menstrual migraine," said Monica Christmas, MD, associate professor of obstetrics and gynecology at the University of Chicago.

Your estrogen levels go up during your cycle, and when your body realizes it's not pregnant, it prepares for your period, which comes with a drop in both estrogen and progesterone. "It's thought that it's that change in hormone levels that triggers migraine," Christmas says. 

There are two phases when you might notice hormonal migraine happening more often. "People who are in the early period of menopause often have very frequent exacerbations in migraine," Christmas says. That's because your hormones are swinging, which can shorten your cycle. When your ovaries aren't making estrogen as regularly, they start to "rev up," creating a surge in estrogen, Christmas says. Sometimes, this can cause "loop cycles," which is when you have two periods back to back.

And for those in a later stage of menopause, they might not have a period for six months but then see it return — and with it, their migraine, Christmas says.

Perimenopause can also indirectly cause migraine. As hot flashes or night sweats keep you up at night, that lack of sleep can also trigger migraine attacks. "The way we can manage them is to make it so that your hormone levels stay even," Christmas says.

What used to be called hormone replacement therapy (HRT) is now just called hormone therapy. "Replacement makes it seem like it has to be done, but not everybody needs to be on it," Christmas says. 

Hormone therapy is prescribed to help with any symptoms caused by changing levels of estrogen and progesterone. "One of the biggest reasons that people take hormone therapies is because it's one of the most effective treatment options for managing hot flashes and night sweats," says Christmas. 

Hormone therapy can also help if you're experiencing vaginal dryness or irritation, or issues like frequent urination, which are part of what's called genitourinary syndrome. Hormone therapy also offers other benefits, such as protection against bone loss. For those who experience premature (before 40) or early (before 45) menopause, hormone therapy can also provide some protection against the increased risks of cardiovascular disease and cognitive decline that are linked to a drop in estrogen.

While hormone therapy may help women with migraine, it's not prescribed to treat migraine alone, Christmas says. But if your doctor thinks your migraine is caused by your swinging hormone levels, keeping them stable during perimenopause can be very helpful, she adds. 

For instance, those in early perimenopause "could consider using hormonal birth control in a continuous way, where they take active pills every day, not even taking the placebo, so that they don't get that drop-off in their hormones," Christmas says.

This is the best option for treating menstrual migraine at this stage. It's better than hormone therapy because it gives you a more continuous dose of estrogen, Christmas says. But if you experience aura as a symptom, Christmas doesn’t recommend hormonal birth control because it puts you at a higher risk for stroke.

Hormone therapy could be an option to manage menstrual migraine for those in late perimenopause -- meaning you’re skipping your period for more than 60 days -- because it may provide enough stability to prevent the change that triggers migraine. But Christmas adds she wouldn’t prescribe hormone therapy for migraine alone. She'd only recommend it if a patient was dealing with symptoms like hot flashes. 

While hormone therapy doesn't have a direct impact on sleep, addressing perimenopausal symptoms can have secondary effects. "If somebody's having really debilitating hot flashes and night sweats, these symptoms are probably disrupting their sleep," Christmas says. "If we can help manage those hot flashes or resolve them, they'll sleep better and their migraine might be better as well."

There's some evidence that people taking some forms of hormone therapy can experience more frequent migraine attacks than those not taking hormone therapy, but more research in this area is needed to understand the link.

Systemic hormone therapy sends hormones — estrogen and progesterone — through your bloodstream to your entire body. There are two types. The first is oral drugs, meaning as a pill you can take. While simple, it has one clear drawback. These pills are processed through your liver, which can put you at a higher risk of blood clots. While that risk is low, migraine is already linked to a risk of stroke and heart attack, so it's likely something your doctor will consider in helping you choose the right option.

But there are other options that don't carry the same risk for stroke or a heart attack, including drugs that enter through your skin called transdermal medications. "There are lots of different transdermal options for estrogen — there are patches, there's a gel, there's a spray, and even a vaginal ring," Christmas says.

If you still have a uterus, you'll need to take hormone therapy for both your estrogen and progesterone levels. Taking progesterone can lower your risk of getting uterine cancer, which goes up if you're just taking estrogen alone. 

If you don't want to take a pill for hormone therapy, the only transdermal option that offers both estrogen and progesterone is the patch. "If somebody wanted a vaginal ring, for instance, then we would have to give them two medicines," Christmas says. You'd need to combine a transdermal spray, gel, or vaginal ring that provides estrogen with either an oral pill or an intrauterine device (IUD) that has progesterone to limit the risk of developing certain cancers.

For those with migraine, Christmas recommends a hormone therapy patch, gel, or spray rather than an oral option. These options don't raise your risk of blood clots the way pills do. They also deliver hormones more steadily compared to pills, which can help you avoid hormonal changes that can trigger migraine in the first place.

Christmas says the results of hormonal therapy can be seen pretty quickly, and that it can be highly effective in improving symptoms such as hot flashes and night sweats. For those experiencing vaginal dryness or irritation, some patients even see a 100% improvement in symptoms, Christmas says, especially if it's a matter of itchiness or irritation. But some symptoms, like pain during sex, can take longer to resolve. 

HRT isn't a direct treatment for migraine, though it can ease menopausal symptoms that may trigger migraine attacks, such as hot flashes that interrupt your sleep. Even if treatment does help, it may take up to three months to see an improvement in migraine symptoms with hormone therapy. 

"I always tell people, 'Don't just use it for a week and think it didn't work,'" Christmas says. "It takes up to six to eight weeks to see the maximum benefit."

Some women, especially those in perimenopause who are still experiencing large hormonal fluctuations, may actually experience more migraine while taking HRT, so always talk with your doctor about the best option for you.

Systemic hormone therapy is not recommended for everyone. If you have any cardiovascular risk factors, such as if you've had a stroke, heart attack, or blood clots like deep vein thrombosis or a pulmonary embolism, being on hormone therapy can increase those risks.

Your doctor will likely also consider your risk of breast cancer and endometrial cancer. If you have had either type of cancer, your doctor won't want to prescribe you estrogen, as that may cause the cancer to return.

Even if you have one of these risk factors, low-dose hormone therapy vaginal creams may still be an option for you.

Your doctor will also consider your age. If you're over 60, some of the risks may exceed the benefits. For instance, the longer you take hormone therapy, the higher your risk for breast cancer.

Talk to your doctor about the best option for you based on your risk factors, age, and symptoms.

Although you might expect menstrual migraine to stop when you enter perimenopause, they can actually get worse for a time as your hormone levels begin to fluctuate. Hormone therapy isn't a silver bullet for hormonal migraine, but it could help level out your hormones to limit hot flashes and help you get better sleep, which may lead to fewer migraine episodes in the long run. Your health care provider will consider your age, medical history, and other health factors to help find the best treatment option for you.