• Treating Menopausal Migraines

    by Wendy R. Hurst, MD, PA
    on Jun 9th, 2018

Migraines are a relatively common chronic pain condition, affecting about 28 million adults in the United States. But did you know that migraines are predominately a female problem? Women account for 70% of all migraine cases, a fact that may be connected to normal cyclical fluctuations in estrogen.   

About nine in 10 adults affected by chronic migraines began having them before the age of 40. In fact, most people who get regular migraines had their first one sometime in their late teens or early twenties. Chronic migraine headaches often become less severe, less frequent, and may even disappear altogether right around the age of 50, which is very close to the average age for menopause in the US.  

It hardly seems fair, then, that for some women menopause seems to have the opposite effect, either intensifying an existing migraine problem or triggering migraines for the first time ever.


Here’s what you should know about menopausal migraines and what kinds of treatments Dr. Hurst offers.

Understanding migraines

Migraines are a type of primary headache, meaning they stem from a problem within the pain-sensitive structures of your head, which includes the nerves, muscles, and blood vessels around your skull, as well as the chemical activity in your brain. Unlike secondary headaches, migraines aren’t a symptom of an underlying health problem, such as a brain tumor.

Migraines are distinguished by a moderate or severe pulsing sensation that may feel more intense on one side of your head. Migraines may last as little as four hours or as long as three days.

In the hours before a migraine strikes, many women experience subtle cues that signal an impending attack, including mood changes or neck stiffness. Some women also have sensory symptoms, such as seeing bright spots or flashes of light or a distorted sense of smell, taste, or touch.

During a migraine, many women experience lightheadedness, sensitivity to light and sound, nausea or vomiting, and blurred vision. When the pain finally subsides, it’s not uncommon to experience weakness, dizziness, or confusion.  

Hormones and headaches

Although brain specialists still don’t fully understand exactly what causes migraines, most researchers think they’re directly prompted by changes in brain chemical levels. It’s believed that such changes can lead to inflammation that swells blood vessels and presses on nearby nerves, resulting in pain.

But what, exactly, causes the chemical changes in your brain that lead to a migraine? Just as your own chemical makeup is unique, the answer to that question is highly individual. Women who suffer from migraines typically react to a wide range of influencing factors, or triggers.


Some of the most common migraine triggers include:

Hormonal fluctuations are actually a major migraine trigger for many women; in fact, half of all women who suffer from chronic migraines throughout adulthood say they usually experience migraines just before their menstrual period, when estrogen levels are falling.

This helps explain why existing migraine problems often become worse during perimenopause when estrogen levels are on the decline. This is also the time when women who never had a migraine may experience a hormone-triggered migraine for the first time.

Evidence suggests that hormone-triggered migraines may ultimately be linked to changes in the serotonin levels of your brain.

Effective treatment strategies

It would be easy to conclude that hormone replacement therapy (HRT) -- the same treatment that’s often used to address other common menopause symptoms like hot flashes, night sweats, mood swings, and vaginal dryness -- may also help prevent hormone-related migraines. While HRT can help some migraine sufferers, it isn’t a straightforward solution for all women.

First, HRT isn’t a viable treatment for women with certain medical histories, including those who’ve had breast cancer or hormone-related cancers. Second, even when HRT is a safe option, it’s hard to know how it will affect your migraines; it could alleviate them, or it could make them worse. Finding the right dose and delivery method is often the key to successfully reducing hormone-triggered migraines with HRT, and Dr. Hurst monitors your dosage to provide optimal relief.

If you aren’t a good candidate for HRT, don’t worry -- there are steps you can take to tame your migraines. First, keep a diary so you can identify and start avoiding any known triggers whenever possible. Your headaches may be hormone-driven, but they may also be partially triggered by stress or lack of sleep, for example.  

Healthy lifestyle changes can also provide relief from hormone-related migraines as well as other menopause symptoms. Besides getting enough sleep, you should also exercise regularly and eat a nutritious, whole-foods diet centered on vegetables, fruits, whole grains, lean sources of protein, dairy, and healthy fats. For many women, these changes are enough to prevent migraines or reduce their frequency and severity.  

When lifestyle changes aren’t enough, however, your treatment plan may also include pain relief medications you can take during a migraine or preventive medications that aim to reduce the frequency or severity of your headaches.

If you’ve been experiencing hormone-related headaches, Dr. Hurst can help you identify your triggers and manage your symptoms. To make an appointment, phone our office in Englewood, New Jersey, or click the button to contact us.

Author Wendy R. Hurst, MD, PA Board certified gynecologist Dr. Wendy Hurst is recognized as one of the most esteemed gynecologists in the New York area.

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