If you have migraine, you may notice changes around the time of menopause.
On this page, you’ll find information about why these changes happen, what to expect and treatments that may help.
Migraine during perimenopause
Migraine after menopause
Treatments for migraine around the time of menopause
Medically induced menopause and migraine
Perimenopause is the time leading up to your final period (menopause), when levels of the oestrogen hormone drop by up to 90%.
Many women find their migraine changes during perimenopause. Some women have worse migraine symptoms and others experience no change. It’s also a time when women can get migraine for the first time.
If you have migraine, especially menstrually-related migraine, you may be more likely to have severe menopausal symptoms.
Your experience of migraine triggers and attacks can change during perimenopause.
Hormonal fluctuations can make your brain more sensitive to migraine. Women with menstrually-related migraine may find their migraine gets worse or needs to be managed differently in the lead-up to menopause.
Some menopausal symptoms can trigger migraine. For example:
You may also have extra family and work pressures at this stage of life. This can cause stress and trigger migraine.
If your migraine symptoms change during perimenopause, ask your doctor to review your treatment plan and recommend changes if needed.
During perimenopause, you might experience new triggers or find existing ones get worse. It’s a good idea to start a new symptom diary and share this with your doctor. They may be able to recommend lifestyle changes to reduce your risk of migraine attack.
If your migraine triggers and symptom patterns change during perimenopause, it’s important to review your treatment plan. Your doctor may recommend different medicines or doses that help you manage symptoms.
You can also ask your doctor about hormone medicines to prevent migraine attacks, for example, triptans.
During perimenopause, which usually happens in your 40s, you can use the Pill to even out hormones that can vary during your menstrual cycle.
If you have migraine without aura, the Pill can be taken every day, without the usual 7-day break that causes a drop in oestrogen levels.
If you have migraine with aura, progestogen-only contraceptives may be a good option.
Magnesium may help prevent and treat migraine attacks, especially if you have migraine with aura or menstrual migraine. Ask your doctor about doses and when to take magnesium supplements.
Everyone’s experience of migraine after menopause (postmenopause) is different.
When your periods stop, there’s a big drop in oestrogen, progesterone and testosterone hormone levels. For many women, this causes menopausal symptoms to continue well into postmenopause. The drop in hormone levels can also trigger migraine.
Menopausal symptoms such as hot flushes, sleep problems, stress and low mood may also increase the likelihood of migraine.
Some women get fewer attacks after menopause but this can take a few years to happen. Other women still have migraine attacks after menopause, but they may see small improvements over time.
If your migraine attacks were linked to hormonal changes, like periods, your migraine is more likely to improve after menopause.
You may be less likely to see an improvement in migraine after menopause if:
You can continue to use the same medicines to ease migraine symptoms after menopause, especially if your migraine triggers are non-hormonal.
If your migraine is worse after menopause and hormonal medicines don’t help, talk to your doctor about other options, such as calcitonin gene-related peptide antibodies (CGRP) treatment. Also check if you can get CGRP treatment on the PBS.
Some treatments help ease migraine symptoms during perimenopause, at menopause and beyond. But if your migraine patterns change, talk to your doctor about changing the medicine or dose.
You can take pain-relief medicine and triptans as normal during perimenopause and at menopause. But if you get migraine attacks more often, be careful about medication overuse headache (MOH), where you have more severe or frequent headaches. Ask your doctor about this. They may recommend other options while attacks are more frequent.
There are many practical things you can do to ease migraine symptoms at this stage of life. For example, try to:
You can also:
Ask your doctor about the benefits and risks of MHT. Depending on your situation, MHT may improve or worsen symptoms of migraine.
Your doctor will consider the type of migraine you have and your medical history before prescribing hormone medicine.
Low-dose hormone therapy may help, especially if you have a low risk of cardiovascular disease, and you start treatment in your 40s or 50s.
Your doctor can recommend a hormone therapy and dose that evens out your hormones. For example, oestrogen patches, gel or spray.
If you haven’t had a hysterectomy, you’ll need oestrogen and progesterone hormone therapy to reduce the risk of endometrial cancer (cancer of the uterus). If you have had a hysterectomy, you'll need oestrogen-only hormone therapy.
Some non-hormone medicines may help with both migraine and menopausal symptoms. For example:
Other non-hormone treatments for menopause are also available.
Ask your doctor about using complementary therapies for migraine and menopausal symptoms. For example, neuromodulation devices and cognitive behaviour therapy (CBT). They will explain the benefits, risks and costs so you can make an informed decision.
CBT is a psychological treatment that can help you manage migraine during perimenopause. It teaches you helpful ways of thinking and relaxation techniques.
Evidence shows that CBT can help with migraine, sleep problems, hot flushes, night sweats, anxiety and depression.
Your doctor can refer you to a therapist who is trained in CBT. You can also ask for a mental health plan, which reduces the cost of your therapy sessions.
Medically induced menopause happens because of surgery or medical treatment, such as chemotherapy or radiotherapy. We need more research to understand how medically induced menopause affects women with migraine.
We know that menopause caused by surgery, for example, the removal of the uterus and both ovaries, makes migraine worse for many women. This is likely due to the sudden drop in oestrogen and progesterone hormone levels.
Medicines used in chemotherapy and radiotherapy can also cause a drop in oestrogen and progesterone levels. But more research is needed to better understand how this affects migraine.
If you have gone through medically induced menopause, ask your doctor if hormone therapy is right for you and how it may impact your risk of migraine attack.
This information was developed in partnership with Migraine & Headache Australia.
This content has been reviewed by a group of medical subject matter experts, in accordance with Jean Hailes policy.
© Jean Hailes Foundation. All rights reserved.
