The menopausal transition can affect headaches in a few ways. Some people may notice headaches for the first time, while others who already have headaches may notice that they either worsen or improve.

Leading up to menopause, the body’s hormonal levels start to fluctuate. This may cause a variety of symptoms, including headaches and migraine episodes.

You might be able to manage your symptoms with home remedies, over-the-counter (OTC) products, or prescription treatments. A healthcare professional can help you make a management plan.

Though the exact connection between headaches and menopause is still being studied, evidence suggests it may be largely hormonal. Estrogen affects a few body processes that may influence headaches.

How estrogen affects headaches

Estrogen influences the production of serotonin and dopamine. These hormones help lower the body’s sensitivity to pain.

So when estrogen drops, serotonin and dopamine levels also decrease. This makes the body more sensitive to pain.

Lower estrogen levels may also lead to increased inflammation, which can play a role in headaches.

Relationship to menstrual cycles

Women are overall more likely to experience headaches. In particular, many people notice headache symptoms around their menstrual cycles, when estrogen levels fluctuate.

As the body’s hormone levels change leading up to menopause, they can affect headache symptoms in a few ways.

The Office on Women’s Health notes that symptoms may worsen or improve depending on whether a person experiences symptom changes around their menstrual cycles.

If you have worse headache symptoms around menstruation, your symptoms may also worsen during the menopausal transition. If you don’t have a history of menstruation-related headache symptoms, you may not notice significant changes in your symptoms leading up to menopause.

A note

Headache symptoms may also be worse for people who have undergone surgical menopause than for those who have experienced natural menopause.

Menopausal people often experience migraine episodes, but they may also have tension-type or cluster headaches.

As noted previously, if you already have a headache disorder, it may worsen or improve during the menopausal transition.

It’s also possible to develop new-onset headache disorders during menopause.

More about headache symptoms and menopause

How common are headaches during menopause?

A 2018 research review suggests that headaches are overall less common during menopause. However, people who already experience headache disorders — particularly migraine — might notice worse symptoms during perimenopause due to fluctuating estrogen levels.

When do symptoms start?

Some people may notice their symptoms changing at the beginning of perimenopause, which is when hormone levels start to fluctuate significantly. Perimenopause often begins in a person’s mid to late 40s, but can begin earlier or later.

How long do headaches last?

Perimenopause typically lasts around 4 years, but it can be different for everyone. For many people, symptoms may improve once the menopausal transition is complete. The transition from perimenopause to postmenopause is done when a person hasn’t had a menstrual period for 12 consecutive months.

For some people, migraine symptoms may persist into postmenopause and can be difficult to manage.

Hormone therapy can help with many menopause symptoms, such as hot flashes and vaginal dryness. However, it’s not clear whether it’s the best treatment for headaches.

The same 2018 research review also notes that hormone therapy may worsen migraine and increase the risk of stroke, though the risks can change based on the dose and type of hormone therapy.

Continuous low dose hormone therapy may be a preventive option for people in perimenopause who don’t have a high stroke risk.

Talk with your healthcare practitioner about your personal and family medical history to determine whether hormone therapy may be a good option for you.

Various other medications can help manage or prevent headache or migraine symptoms. Your doctor may initially recommend common OTC medications, like ibuprofen (Advil) or acetaminophen (Tylenol).

If you’ve already tried those medications, your doctor may prescribe medications such as:

  • triptans like sumatriptan (Imitrex)
  • gepants like rimegepant (Nurtec)
  • anticonvulsants like topiramate (Topamax)
  • blood pressure medications like candesartan (Atacand)

Medications that can manage other menopause symptoms, like hot flashes and night sweats, may also help with migraine episodes. These include antidepressants like escitalopram (Lexapro) or nerve medications like gabapentin (Neurontin).

Your doctor will recommend a medication based on your symptoms and medical history.

Apart from hormone changes, many factors can contribute to headaches and migraine episodes, so managing your symptoms may require more than one approach.

For example, psychological stress may be a trigger for some people. If that’s the case for you, it may help to try to relieve your stress through activities like meditation, exercise, or therapy.

People experiencing menopause may also have trouble falling or staying asleep, which may contribute to headache symptoms. In addition to traditional measures like keeping your bedroom dark and cool and sticking to a consistent sleep schedule, you could consider pursuing treatments like cognitive behavioral therapy for insomnia.

A healthcare professional can help you figure out a management plan that’s right for your specific situation.

Tip

Tracking your symptoms during menopause may help you identify trends in your symptoms and possible triggers. Try to be thorough — noting things like what you eat, what medications you take, and how you’re feeling emotionally can be helpful.

Symptom tracking can also help your doctor recommend an appropriate treatment or understand how well your current treatment is working.

Learn more about tracking your menopause symptoms or download a printable symptom tracker.

For some people, headaches and migraine episodes may worsen during the menopausal transition.

A healthcare professional may recommend one or more management methods, including hormone therapy or other medications. You might also be able to make some changes at home to manage triggers like stress or sleep disturbances.

If you need help managing your symptoms, contact a healthcare professional. Tell them about your symptoms, whether you’ve noticed any specific triggers, and what treatments you’ve tried so far.

Want to dig deeper?

Check out the Migraine and Menopause resource centers. You can also sign up for our Menopause newsletter to learn about symptoms, treatments, and more.