Menopause, Perimenopause, and Migraine: Understanding the Impact on Migraine Symptoms

Menopause and perimenopause can significantly affect migraine symptoms, often in unexpected ways. Many women anticipate that migraine will improve after menopause, but the reality can be different.

This guide explores how the hormonal changes associated with menopause and perimenopause can influence migraine and what treatment options are available for those whose symptoms worsen during this time.

Understanding Perimenopause and Menopause

  • Perimenopause: Refers to the years leading up to menopause, usually lasting 5-8 years. During this period, estrogen levels fluctuate significantly, and menstrual cycles can become irregular. This fluctuation can often lead to an increase in the frequency and severity of migraine.
  • Menopause: Defined as one year after the last menstrual cycle. After menopause, estrogen levels are low and stable. For some women, particularly those with migraine attacks triggered by estrogen fluctuations, this can lead to a reduction in migraine frequency.

What Typically Happens to Migraine During Menopause?

  • Migraine Patterns During Perimenopause: Many women find that their migraine attacks worsen during perimenopause due to fluctuating estrogen levels. The frequency, duration, and intensity of migraine attacks can increase during this stage.
  • Migraine After Menopause: While some women may experience relief from migraine attacks after menopause, this is not guaranteed. Women with migraine that is not primarily affected by hormonal changes may see little to no improvement.

Hormone Replacement Therapy (HRT) and Migraine

Hormone replacement therapy (HRT) is often used to manage symptoms of menopause, but its effects on migraine can vary:

  • Effectiveness of HRT: Approximately 45% of women with migraine experience improvement with HRT, another 45% may experience worsening symptoms, and 5% may see no change.
  • Transdermal Delivery: Current guidelines suggest using transdermal (skin patch) forms of HRT rather than oral forms, as this method reduces the risk of stroke and other complications.
  • Individualized Approach: The response to HRT can be highly individualized, and it should be monitored carefully by healthcare providers.

Is a Hysterectomy or Oophorectomy a Solution for Migraine?

  • No Evidence to Support Hysterectomy/Oophorectomy: There is no indication that removing the uterus or ovaries helps with migraine management. In fact, these procedures can sometimes worsen migraine symptoms.
  • Increased Risk of Complications: Surgical menopause can lead to other complications, such as an increased risk of dementia, and should not be considered as a treatment for migraine without other compelling reasons.

Managing Migraine Symptoms During Menopause

If migraine attacks worsen during perimenopause or menopause, consider the following strategies:

  • Stabilize Hormone Levels: Work with a gynecologist to stabilize estrogen levels using methods like the pill, estrogen patches, or other hormonal treatments.
  • Non-Hormonal Approaches: For those who cannot use hormonal treatments (e.g., due to breast cancer or other conditions), focus on aggressive preventive strategies, such as multiple preventive medications and acute treatment options.
  • Monitor for Risk Factors: Assess family history for clotting disorders, ensure that the individual does not smoke, and consider genetic factors before starting any hormone-based treatments.
  • Keep a Migraine Diary: Track symptoms, migraine frequency, and hormonal changes to identify patterns and adjust treatment strategies accordingly.

When to Talk to a Healthcare Provider

  • Frequent or Worsening Migraine Attacks: If you notice an increase in migraine frequency or severity during perimenopause or menopause, consult a healthcare provider.
  • Considering Hormone Replacement Therapy: If you are considering or currently using HRT, discuss with your doctor its potential effects on migraine and the best method of administration.
  • Concerns About Surgery: If you are contemplating surgery like a hysterectomy or oophorectomy, ensure it is for appropriate medical reasons and not solely for migraine management.

Menopause and perimenopause can significantly affect migraine, and each woman’s experience may differ. Understanding the potential changes and knowing your options for managing symptoms can help navigate this challenging period. Always consult with your healthcare provider to find the best approach tailored to your individual needs.

This resource is based on HeadWise Episode 66, Changes to Migraine During Menopause with Jan Brandes, MD
Published, 07/24/2020

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