Migraine and menopause

Perimenopause is the time leading up to your final period (menopause), when oestrogen and other hormones levels drop.

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:

• poor sleep
• dehydration due to hot flushes and night sweats
• heavy periods
• anxiety
• depression.

You may have extra family and work pressures at this stage of life, which can cause stress and trigger migraine.

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 migraine 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:

• your first attack happened in childhood or as a teenager
• you have chronic migraine (15 headache days or more per month for at least 3 months)
• your migraine attacks are usually linked to non-hormonal triggers.

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. Ask if you can get CGRP treatment on the Pharmaceutical Benefits Scheme (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), which can cause frequent and severe headache. Ask your doctor about the benefits and risks of using these medicines.

There are many practical things you can do to ease migraine symptoms at this stage of life. Try to:

• get good sleep
• do regular physical activity
• eat healthy food
• drink plenty of water.

You can also:

• limit alcohol
• limit caffeine (unless caffeine helps to prevent and treat attacks)
• maintain a healthy weight range
• manage stress (e.g. relaxation or mindfulness techniques, such as breathing or yoga).

Ask your doctor about the benefits and risks of using 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 migraine and menopausal symptoms. For example:

• antidepressants, such as amitriptyline (for migraine and sleep) and venlafaxine (for migraine and hot flushes)
• gabapentin (for migraine and hot flushes).

Other non-hormone treatments for menopause are also available.

Medically induced menopause happens because of surgery or medical treatment, such as chemotherapy or radiotherapy.

More research is needed to understand how medically induced menopause affects women with migraine.

We know that menopause caused by certain surgeries, for example, a hysterectomy, 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 impacts migraine.

If you have experienced medically induced menopause, ask your doctor if hormone therapy should be part of your treatment plan.