Many women find their migraine changes during perimenopause. Some women have worse migraine symptoms and others experience no change. It’s also a time when women can get migraine for the first time.

If you have migraine, especially menstrually-related migraine, you may be more likely to have severe menopausal symptoms”.²

Hormonal fluctuations can make your brain more sensitive to migraine. Women with menstrually-related migraine may find their migraine gets worse or needs to be managed differently in the lead-up to menopause.

Some menopausal symptoms can trigger migraine. For example:

• Poor sleep
• Dehydration due to hot flushes and night sweats
• Heavy periods
• Anxiety
• Depression.

You may have extra family and work pressures at this stage of life, which can cause stress and trigger migraine”.⁴ 

The type of HRT is important as some forms of HRT can create more hormone fluctuations, triggering migraine. This is more likely to occur with oral HRT than with patches or gel. We generally recommend that women with migraine who need HRT should use estrogen patches, gel or spray, known as transdermal estrogen, as these provide more stable hormone levels than tablets”.⁵

• Your headache keeps coming back
• Painkillers do not help and your headache gets worse
• You have a bad throbbing pain at the front or side of your head – it could be a migraine or, more rarely, a cluster headache
• You feel sick, vomit and find light or noise painful
• You regularly get headaches before or during your period”.⁶