As you go through the hormonal shifts of perimenopause before menopause, a lot of things change in your body. If you’re someone who has lived with migraine, you may wonder what these changes will mean for your migraine. After all, hormones are a common culprit for many women’s migraine attacks. About 60% of all women who live with migraine say there’s a connection between their period and their migraine bouts.
Unfortunately, fewer periods don’t usually translate to fewer or less intense migraines. In fact, research shows the opposite: Perimenopause can actually be a time of more frequent, intense, and harder-to-treat migraine attacks — even if your migraine attacks were well-controlled and stable before.
April Bradley, 54, who has lived with migraine since childhood, says she thought perimenopause would bring some relief to her migraine woes, but she was hit with even worse symptoms.
“Hot flashes in particular were a major trigger,” says Bradley. “The sudden wave of heat and the jolt of adrenaline that came with them often tipped my nervous system over the edge. Within hours, I would be hit with a migraine — sometimes more intense than I had ever experienced before.”
If you’re on the road to menopause or already there, it’s good to understand how this might affect your migraine and how you might manage these changes. Eight women in the same boat share their experience and best advice.
Why Perimenopause and Menopause Can Make Migraine Worse
Hormonal changes are one of the biggest reasons migraine patterns shift at midlife. During perimenopause, estrogen and progesterone levels rise and fall wildly before finally declining.
“These higher fluctuating levels of FSH [follicle-stimulating hormone] and estrogen can lead to a greater premenstrual drop in estrogen levels,” says Nina Riggins, MD, PhD, neurologist and chair of the women’s health special interest group of the American Headache Society. “Estrogen drop has been one of the proposed triggers of migraine attacks during the menstrual cycle.”
This roller coaster effect can make migraine attacks more frequent, more severe, or simply different than before.
“Migraine can be accompanied by changes in mood, cranial autonomic symptoms including sweating, temperature dysregulation, and multiple other symptoms that potentially can overlap with some perimenopausal symptoms,” she says.
Both perimenopause and migraine can cause:
- Hot flashes and night sweats
- Sleep problems or insomnia
- Fatigue and brain fog
- Mood swings or anxiety
- Nausea or dizziness
- Sensitivity to light and sound
What about when you fully hit menopause, and your periods finally stop for good? Once estrogen and progesterone levels get stable after menopause, it’s possible you can finally see relief. But this isn’t the case for everyone, says Riggins.
“About 67% of women have migraine improvement after spontaneous menopause,” Riggins says. “And for 9% of people, migraines get worse.”
Knowing these statistics is a good way to prepare yourself for whatever is to come. With help from your doctor and advice from others living through it, you can find tools to manage migraine and menstrual changes.
Advice From Women Living With Migraine in Midlife
While your perimenopause and migraine journeys are unique to you, there are many others living with both conditions. You may find some hope and help from their experiences.
Their advice varies, but a common thread is this: Migraine isn’t “just a headache,” and while lifestyle changes can be a help, they aren’t a cure. You’re living with a neurological condition that requires medical help. The choices you make about diet, exercise, and stress are supportive, not miracle solutions that will make migraine go away for good. It may take some trial and error, but medications and other therapies can and do offer real relief from migraine.
Eight women offer their best tips:
Find a specialist who cares
When Bradley’s hot flashes began making her migraine worse, it pushed her to look beyond primary care. Working with a neurologist who understood the interplay between hormones and migraine, she found relief with the calcitonin gene-related peptide (CGRP)-blocking medication atogepant (Qulipta).
“Now I have only a handful of migraines each year,” she says. “My advice: Trust your lived experience and don’t give up. Find a doctor who collaborates with you.”
Prioritize exercise
Julianne Mesaric, 41, has had migraine attacks since early childhood, but they changed dramatically in her late 30s. “They came back with a vengeance — faster, more intense, like a hurricane instead of a steady current,” she says.
Then perimenopause shifted her triggers in ways she could not imagine. She’s found major relief with an abortive medication she takes when a migraine episode hits — the CGRP receptor antagonist ubrogepant (Ubrelvy). But she says she also notices improvement in her migraine when she gets regular exercise.
“We need to be building muscle mass and doing strength training at this age, and I have taken that to heart by strength training two to three times a week,” she says. “I still get migraines with the same frequency, but it helps the intensity.”
Be thoughtful with hormone replacement therapy (HRT) therapy
For Leslie Walla, 43, migraine attacks have been genetic and lifelong. They worsened in her 30s and again during perimenopause. It wasn’t until she tried Botox that she saw a major shift in her symptoms.
“Nothing else has helped me as much,” she says. “Botox reduced both the frequency and the intensity of my migraines.”
These days, Walla is also on hormone replacement therapy (HRT) for perimenopause, and during the process of getting that prescription, she was careful to be up-front about her migraine history with her doctors.
“Because I have migraine with aura, I can’t be on birth control — it increases stroke risk. I use estradiol instead,” she says. “If you have migraine and are looking into HRT, make sure your provider knows your migraine history.”
Riggins adds that higher doses of estrogen can trigger migraine for some people — another reason to make sure your doctor knows your whole health story.
“Because of vascular concerns, especially for people with migraine with aura, we usually prioritize nonhormonal therapies,” says Riggins.
Recognize the early signs
Kelle Burns, 63, developed migraine in her 40s alongside perimenopause and fibromyalgia. Her doctors offered up multiple diet changes and supplements, but they didn’t help at all.
“I tried everything,” says Burns. “But it was medication that finally worked.”
Now she recognizes her early warning signs — such as yawning, sparkles in her vision, and sugar cravings — and stops her attacks early with eletriptan (Relpax) or rizatriptan benzoate (Maxalt). These are drugs called triptans that shrink blood vessels and change how your brain senses pain signals, which helps ease migraine pain.
“The idea that it’s not a headache changed everything,” she says. “If I want to keep functioning, I take the medicine as soon as I feel it coming.”
Nail down your triggers
Elissa Pope, 48, is another person with lifelong migraine. She averages about three to four migraines each month now, but in her worst months, she has had as many as 15.
It was during hormonal treatment for breast cancer that Pope saw a rise in her migraine intensity and frequency. She says this time period forced her to learn as much as possible about her triggers so she could regain some control.
“When you know those, you hold a lot more power over getting to them quickly — or avoiding them altogether,” says Pope.
Allow yourself to rest
Mary Keenan, 63, says her migraine began in her early 50s with the onset of perimenopause. “At first I thought it was allergies,” she says, “but I realized perimenopause was the cause.”
Now that she’s postmenopausal, her migraines are less frequent. Still, she stays on top of medical management and listens to her body’s cues to know when to stop and rest.
“Medication at the first sign — plus a nap — gives me a fresh start,” says Keenan.
Have a consistent action plan
Jane Myers, 47, has had migraine attacks with aura since she was a child. They got worse in her early adulthood, then eased during pregnancy. Now in perimenopause, they’ve returned more regularly. She says she focuses on getting through the aura with remedies that have worked for her before, including a 10-milligram dose of the nonsteroidal anti-inflammatory drug (NSAID) meloxicam to get relief from both the headache and the hangover feeling after the migraine passes.
“If I can get through the aura, I can make it through anything,” says Myers. “Although meloxicam does not help with the aura time decreasing, it does help significantly with the after effects. Whenever possible, I also try to put a blanket, pillow, or jacket over my head, depending on where I am, and close my eyes. I also drink as much water as possible on onset.”
Look for patterns
For Meg Clark, 40, migraine changed after her pregnancy and again with perimenopause. “My auras disappeared — which was a bummer because that was a nice heads-up to let me know a migraine was on its way — and now they’re tied to who knows what, mostly the weather,” she says.
She uses magnesium and riboflavin for prevention and tracks her attacks meticulously.
“Do a debrief so you know what was going on before your migraine,” says Clark. “That’s how I realized that if a tornado watch was issued, I should go ahead and take my meds.”
Other Ways to Manage Migraine
It may take you some trial and error to find what works for your migraine as they shift alongside your perimenopause symptoms. Along with medication, Riggins endorses a whole-health approach to help with your migraine.
“Addressing sleep, diet, physical activity, and response to stress is very important during this period of time,” she says. Even though they can’t fully cure your migraine, these factors can help:
Get good sleep. Keep your sleep schedule as consistent as possible, and let your doctor know if you’re struggling to get a good night of sleep. You may need a sleep study to look for issues such as sleep apnea.
Drink water. About 1 in 3 people with migraine say that dehydration is a major trigger. Try drinking more water daily by carrying a water bottle to remind you to sip throughout the day.
Move your body. It can be hard to feel motivated to exercise with symptoms of perimenopause or migraine. But physical activity not only helps improve your circulation but also stabilizes your hormones. Even a brisk walk around your neighborhood or 30 minutes of at-home yoga several times a week can make a difference.
Eat mindfully. Once you know a food triggers your migraine, take care to avoid it. But also notice how certain foods can affect you in other ways. For example, says Riggins, caffeine can stay in your body for hours, so limiting your intake later in the day can help support better sleep — another boost for migraine management.
Build a support network. Migraine can be isolating, especially when it disrupts work, relationships, or daily plans. Riggins encourages joining online migraine communities for shared support and advocacy.
