Headaches / Migraines (Menopause-Related Changes)
The hormonal fluctuations of perimenopause can significantly impact headache and migraine patterns. Some women experience worsening or more frequent migraines, particularly those whose migraines were previously linked to their menstrual cycle (menstrual migraine). Others may develop migraines for the first time. Conversely, some find their migraines improve after menopause when estrogen levels stabilize. Changes in sleep, stress, and other menopause symptoms can also act as triggers. Keeping a headache diary and working with a doctor are key to management.
Management Strategies
- Continuous combined HRT or estrogen patches may help stabilize estrogen levels and reduce hormonally-triggered migraines in some postmenopausal women (requires careful consideration/consultation). Low-dose hormonal contraceptives may help regulate cycles/headaches during perimenopause.
- Headache diary to identify triggers and patterns.
- Regular sleep schedule
- Stress management
- Regular meals (avoid skipping)
- Adequate hydration
- Regular exercise
- Identifying and avoiding personal triggers (dietary, environmental)
- Over-the-counter pain relievers (NSAIDs, acetaminophen)
- Triptans (e.g., sumatriptan)
- CGRP antagonists (e.g., ubrogepant, rimegepant)
- Beta-blockers, antidepressants (amitriptyline), anti-seizure medications (topiramate), CGRP monoclonal antibodies (e.g., erenumab, fremanezumab)
- Botox injections for chronic migraine
Impact
- Reduced quality of life
- Missed work/activities
- Difficulty concentrating
Diagnostic Considerations
Based on headache history and pattern changes. Neurological evaluation needed if headaches have concerning features ('red flags') like sudden severe onset ('thunderclap'), associated neurological symptoms, fever, stiff neck, or significant change from typical pattern.