What Should Women with Migraine Know About Menopause?

January 26, 2024
March 7, 2022
What Should Women with Migraine Know About Menopause?

Every woman has a long journey of dealing with hormonal changes throughout her life. The transition to menopause tends to be a very long process with lots of hormonal fluctuations, which can sometimes trigger and/or worsen migraine attacks.

How menopause can affect migraine

The changes in hormone levels such as estrogen can worsen migraine attacks, change their frequency, severity, and even character and associated symptoms during that time:

  • Women with migraine are at increased risk for symptoms of menopausal transition such as hot flashes.
  • For women who have never experienced a migraine attack, sometimes menopause can cause this to begin: About 8 to 13% of women who undergo menopausal transition start to have migraine attacks for the first time of their lives.
  • Some women begin the menopause transition earlier than they naturally would have due to "surgical menopause" - which occurs when the ovaries are surgically removed, as they are the main source of estrogen production in the female body. The good news is that menopause induced by surgically removing the ovaries does not lead to migraine worsening, because surgical menopause is not associated with all the changes in hormone levels of natural menopause.

The good news is that the vast majority - about 2 in 3 women with migraine - notice an improvement in their migraine after the menopausal transition is completed and their hormone levels stabilize, especially for the women who had worse migraine attacks around their menses. Unfortunately, however, migraine aura does not tend to improve after menopause.

As always, it is very important to discuss any changes in your headache symptoms or new headaches with your doctor. Your doctor will want to get more information on the changes and evaluate the reason for those changes.

Solutions for migraine during menopause

There are ways to help with the increased in migraine attacks and the menopausal symptoms, if you are experiencing them.

  • For example, venlafaxine is a medication that can both help with migraine prevention and hot flashes.
  • Hormone replacement therapy with low dose estrogen may help treat the increased migraine attacks around menopause and menopausal transition symptoms, but comes with some risks such as increased risk of blood clots and stroke. (From the scientific data available so far, it seems that a hormone replacement therapy patch placed on the skin is safer than medications taken by mouth from a stroke risk standpoint.) The specific risks, benefits, doses, and types of hormone replacement therapy are individualized and should be discussed with your doctor.

Entering a new stage in life can be challenging both physically and emotionally, and surrounding yourself with a supportive team of experts can make a big difference. You can join Neura Health to get headache or migraine help from top neurologists who are experts in their field, and who have treated thousands of women for these conditions during the menopausal transition.


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Olivia Begasse De Dhaem, MD
Dr. Olivia Begasse de Dhaem is a board-certified and fellowship-trained neurologist and headache specialist, and an Advisor to Neura Health.
About the Author
Dr. Olivia Begasse de Dhaem is a board-certified neurologist and Headache Specialist at Hartford HealthCare in Milford CT. She graduated from Columbia University College of Physicians medical school. She attended her neurology residency at the Columbia University Neurological Institute. She completed her headache medicine fellowship at Harvard University. She is an emerging leader of the American Headache Society. She is involved in advocacy and feels strongly about supporting people with headache disorders in the workplace.

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