Two out of every five women experience a migraine at some time in their lives, and the majority find them related to their periods. So does that mean menopause will make it better?
The good news is that postmenopausal women experience reduced migraines.
The bad news is that it’s likely to get worse before it gets better. Menopause can even cause these headaches in women who’ve never experienced them before.
Headaches are not unusual when you’re having your period, and most women deal with them in the same way they deal with cramps and other pains.
A migraine, however, is not just a severe headache. Doctors distinguish two different types: with aura and without aura. Both include severe pain in one side of the head or face, which is made worse by movement, noise or bright light, and may be accompanied by nausea or vomiting.
A migraine can last from a few hours to several days. If you have one with aura, you may see flashing lights or floating lines; lose peripheral vision and sensation in your hands or fingers; or have a distorted sense of touch, taste or smell.
There’s no doubt that migraines are related to hormone levels in your blood. There’s a clear link between the drop in estrogen levels before menstruation and the incidence of migraines; many women who take birth control pills find they feel better when estrogen levels are steady but get worse during the pill-free week.
Unfortunately, there’s not a simple causal relationship between estrogen and migraine; hormones control many interrelated systems in your body, and other factors can affect headaches. Also, because every woman is unique, the same levels of estrogen can affect various individuals differently.
Menopause and migraine
The Migraine Trust (migrainetrust.org) report that around 15% of women who experience migraines say that they got better during menopause, but 45% say that they got worse.
Most people assume this is related to estrogen levels fluctuating more widely during perimenopause (in the same way that girls who are starting their periods are more likely to get migraines until hormone levels settle into a regular pattern).
But migraines also get triggered by tiredness and stress, so if you’re waking in the night with hot flushes and having to cope with irregular periods, there are good reasons for migraines to be more common, whatever your estrogen levels.
If you’ve experienced migraines throughout your life, you’ll have a good idea of the things that can set them off. But if you start getting migraines as your body moves into perimenopause, it’s worth keeping a detailed food and drink diary for a month or two. Chocolate, caffeine, cheese and red wine can make migraines worse for many people, but recording what you’ve eaten and drunk before a migraine starts can help you identify what’s right (or wrong) for you.
The effects of hormone replacement therapy (HRT) on migraine are difficult to predict. Some women are helped by having fewer spikes and dips in estrogen levels; some women find their HRT causes or exacerbates their headaches. If you think your HRT is making migraines worse, talk to your doctor about using a hormone patch or gel rather than taking a tablet, as these methods release hormones into your bloodstream much more gradually.
A team from the University of L’Aquila, Italy, conducted a review of the literature on menopause and migraine (ncbi.nlm.nih.gov/pmc/articles/PMC4548761/) and concluded that “The effects of several therapeutic regimens on migraine has also been investigated, leading to non-conclusive results. To date, no specific preventive measures are recommended for menopausal women with migraine.”
In other words, there’s no definite way of preventing or treating hormone-related migraines. If you’ve had migraines before, you’ll know what treatment regime is best for you. If you experience them for the first time during menopause, then see if you can find a painkiller that works for you, eat small meals with healthy snacks in between to keep your blood sugar steady, and try to relax and de-stress as much as possible. Don’t attempt to power on through; that will almost certainly make things worse.
Migraines are related to hormone levels, particularly (though not exclusively) estrogen. Many women who have experienced them throughout their lives find that they get worse during perimenopause (though in most cases they improve after menopause).
Some women have migraines for the first time as their periods become irregular and hormone levels fluctuate. If menopause leads to migraines for you, then talk to your doctor so that you can work out which factors make things worse and find a regimen that works for you.