You’re not just imagining it: There’s a proven link between migraine attacks and hormonal cycles. So if you tend to get more attacks during your period, it’s reasonable to wonder if your symptoms will disappear once you hit menopause and your monthly cycle stops.
There’s nothing wrong with hoping for that, but the reality might be a little more complicated. The truth is that even though researchers know that hormones influence migraine, the impact of menopause on attack frequency and severity will vary from one person to the next. But before we dive into all of the possibilities, let’s back up and make sure we’re on the same page about what “menopause” means.
What is menopause?
What’s the first thing you think of when you hear menopause? Lots of people might say hot flashes or irregular periods, but those are actually symptoms of perimenopause—the years-long phase where you transition out of your reproductive years. Technically, menopause isn’t a long-term experience: It’s the point in your life when your period stops for good, after which you move into postmenopause (and, ideally, migraine-free bliss).
Let’s focus on perimenopause for now, since that’s probably what you were thinking of when you decided to read this. For most people, perimenopause starts in your mid or late 40s, and can last anywhere from two to eight years. You’ll know you’re dealing with perimenopause when your periods become irregular (but you still have at least one every three months). You may also experience hot flashes, mood swings, night sweats or insomnia, and vaginal dryness. Some people also get new or slightly worse tension headaches. Once you haven’t gotten a period for a full year, you’ve officially hit menopause.
All of these changes are caused by the fact that your ovaries have started producing less and less estrogen. But that has a silver lining—a potential decrease in your migraine symptoms.
What’s the link between migraine, hormones, and menopause?
Everyone’s migraine triggers are unique, but most sufferers have at least one trigger in common: change. Sudden shifts to your sleep schedule, stress levels, and even the weather can bring on a debilitating headache, so consistency is key to avoiding attacks.
Unfortunately, the hormonal instability of perimenopause is no exception to this rule. Clinical studies have found that migraine frequency can increase during perimenopause, and some people even suffer their first-ever attacks.
Scientists think this may be because estrogen levels shift unpredictably during perimenopause, as your body adjusts to a new stage of life. Ideally, that would mean you could look forward to a reprieve from migraine once you finally reach menopause and your hormones level out. Of course, the reality is a little more complicated.
The clinical evidence is conflicting on whether or not migraine becomes less severe after menopause. That might mean that once your hormones are stable, the severity and frequency of your attacks is determined by other factors instead, such as your mental health.
How can I treat menopause-related migraine attacks?
Reading all this, you might start to worry that frequent, unavoidable migraine attacks are going to put a damper on your golden years. Luckily, you have options when it comes to fighting perimenopausal attacks: You can use standard migraine treatments to relieve your symptoms, or use hormonal treatments to tackle the problem at its source.
HRT for migraine
If you struggle with menstrual migraine (sometimes called hormonal migraine), you know that oral birth control can be an effective treatment (as long as you don’t have migraine with aura), because it helps stabilize fluctuating hormone levels. During perimenopause, doctors sometimes prescribe hormone replacement therapy (HRT) in hopes of achieving the same effect.
Hormone replacement therapy is exactly what it sounds like: You take medications that replace the hormones (in this case, estrogen) that your body can’t make any more. Thankfully, doctors won’t use HRT to keep your period going forever—the goal is just to manage the pace of your inevitable journey toward menopause. A slower decline in estrogen levels can mean fewer migraine attacks, plus relief from other symptoms of perimenopause like those infamous hot flashes.
However, the scientific record is unclear on whether or not HRT is really effective at treating migraine: Some studies say it is, while others insist more research is needed. The simple truth may be that HRT affects everyone differently. If you’re the cautious type, you might want to stick to a more standard migraine treatment regimen rather than trying out HRT.
Clinically-proven migraine treatments
Looking for something a little more clinically-backed? Then you’ll be glad to hear that typical migraine treatments (think: triptans, NSAIDs, antidepressants, anticonvulsants, anti-CGRPs and beta blockers) are just as effective during perimenopause as they are at other points in your life.
That may not be a relief to hear if you’ve never found the right treatment regimen for your attacks. If that’s the case for you, Cove is here to help. Complete our quick consultation to find out if a Cove doctor can prescribe a personalized treatment plan built for your unique needs.
For many people, the idea of reaching menopause and entering a new phase in your life can be a little intimidating, and maybe even upsetting. And when you factor in physical challenges like hot flashes and night sweats, the last thing you need is migraine attacks adding to your concerns.
Luckily, there are multiple research-backed options for treating migraine symptoms at any age. As long as you continue to prioritize your health as you get older, you can look forward to enjoying more migraine-free years.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Photo by Tino Renato via Death to Stock