Women can experience increased frequency, intensity and longevity of migraines during perimenopause and menopause. This is caused by a fall in natural estrogen levels in the body. 

Migraines can be triggered by perimenopausal symptoms such as night sweats, hot flushes, disturbed sleep and mood swings. Women going through perimenopause are encouraged to follow a healthy lifestyle and take regular exercise to help reduce symptoms that can trigger migraines. 

HRT is also an effective tool for helping to manage perimenopausal symptoms that can trigger migraines during this life stage. There are different ways to administer HRT, including tablets, skin patches, gels and sprays. 

Transdermal HRT applied via the skin is considered the safest form for women who have migraines, with or without aura. HRT skin patches release a steady dose of estrogen that can help women manage their symptoms and reduce the chance of triggering migraines. 

You can learn more about caring for women during perimenopause and menopause with migraines in our main article and our recommended training course for healthcare practitioners in this field. 

Changes during perimenopause

Most women will experience migraines as they approach menopause. Perimenopause is the time in life when periods become less regular and other symptoms, such as migraines, hot flushes, and brain fog, start to become more noticeable.

Perimenopausal symptoms result from changes in the ovaries that can start up to ten years before a woman’s last menstrual period. Migraine with perimenopause and menopause is common, affecting over 90 per cent of women in the UK.

Studies show that migraine frequency, intensity and duration and menopause are closely associated, with migraine symptoms tending to worsen in the years leading up to menopause. Migraine attacks also tend to increase in the early stages of menopause and become less frequent towards the end of menopause. 

However, it can take two to three years after menopause – the woman’s last period, for hormones to settle enough to see relief from migraines. Non-hormonal triggers can still persist for a while after menopause, so if the patient still experiences these, migraine attacks will still continue.

Migraine symptoms in menopause

Migraine symptoms in menopause are similar to any other stage of life, so treatment will usually follow the same basic medical guidelines. However, it can help the patient to understand what causes migraines to worsen during menopause so she can reduce her anxiety around the issue, which can exacerbate the symptoms.

The fluctuation of oestrogen causes the worsening of migraine during menopause. The drop in oestrogen that occurs naturally around menstruation can trigger migraine attacks. As women enter perimenopause in their 40s, menstrual cycles can become more erratic, with more fluctuations in oestrogen levels. 

While HRT isn’t directly used as a treatment for migraine, many women taking HRT during menopause notice that migraines are much reduced due to the medication controlling their menopausal symptoms, which reduces the likelihood of triggering a migraine.

Some forms of HRT can create more hormone fluctuations, triggering migraines. It is generally recommended that women with migraine who need HRT should use transdermal forms of HRT, such as oestrogen patches, gels or sprays.