Migraine and Menopause

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

Menstruation, perimenopause, and menopause all affect individuals with migraine. Menopause is considered when you have missed your period for 12 months. [1]. The average age of menopause is 51, and it occurs in all menstruating women. There are various hormonal and non-hormonal treatments for menopause, in addition to some potential health complications. Migraine is often connected to fluctuations in hormones, which can fluctuate throughout a woman’s lifetime [2]. In today’s blog post, we will discuss the relationship between migraine and menopause.

In the United States, approximately 1.3 million women enter menopause each year [1]. As women grow older, their ovarian follicles diminish in quantity, and there is also a decrease in granulosa cells of the ovary. Granulosa cells are the main producers of estradiol, a hormone responsible for maturing and maintaining the reproductive system, and inhibin, a protein that regulates pituitary follicle-stimulating hormone (FSH) secretion [1]. The decline in estrogen levels disrupts the hypothalamic-pituitary-ovarian-axis, the system that controls reproduction in women. As a result, it prevents endometrial development, which then causes irregular menstrual cycles until they stop.

Hormonal changes are associated with menopause, and it is well-known that hormonal fluctuations also impact migraine attack frequency and severity [3]. The peak prevalence of migraine occurs in pre-menopausal women in their late 30s, 30% of the time. [4]. Hormonal changes may occur before, during, and after menopause, and these fluctuations can contribute to your migraine presentation. Perimenopause occurs in  the months or years leading to menopause. Some symptoms experienced during this time may include hot flashes, insomnia, reduced libido, weight gain, depression, and difficulty concentrating.

In a study examining the relationship between headache frequency and the stages of  menopausal transition in mid-life women with migraine, a higher headache frequency was noted in women during perimenopause compared to premenopause [5]. However, the lack of statistical significance may indicate that there are different mechanisms behind this increased risk. In an article reviewing hormonal strategies used to treat menstrual migraine, they recognized that migraine related to hormonal fluctuations was likely attributed to estrogen-replacement regimens [6].

The acute treatment of migraine during perimenopause include fast-acting triptans (i.e., sumatriptan, rizatriptan), NSAIDS (non-steroidal anti-inflammatory medications) and gepants (ubrogepant and rimegepant). In addition, there are also some preventive treatment options such as Botox, monthly self-injectable medications, oral prescription medications, estrogen supplementation, and magnesium. Regular exercise and a healthy diet have also been shown to improve migraine in menopausal women [3]. Further, complementary therapies such as mindfulness-based cognitive therapy have been shown to reduce headache-related disability in people with episodic and chronic migraine [7].

During menopause, there is a stabilization of hormone levels, so many women report that their migraine attacks decrease after the completion. It is important to discuss with your headache specialist about how perimenopause and menopause can impact your migraine frequency and severity. Keeping a headache diary may also help you and your provider learn how to identify triggers which may be specific to you.

We look forward to helping you at the Westport Headache Institute! – Dr. K

References:

  1. Peacock K, Ketvertis KM (2023) Menopause. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
  2. Pavlović JM (2018) Evaluation and management of migraine in midlife women. Menopause 25:927–929. https://doi.org/10.1097/GME.0000000000001104
  3. Migraine and Menopause. In: American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/migraine-and-menopause/. Accessed 29 Jun 2023
  4. Stewart WF, Roy J, Lipton RB (2013) Migraine prevalence, socioeconomic status, and social causation. Neurology 81:948–955. https://doi.org/10.1212/WNL.0b013e3182a43b32
  5. Martin VT, Pavlovic J, Fanning KM, et al (2016) Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine: Results of the American Migraine Prevalence and Prevention Study: Research Submissions. Headache: The Journal of Head and Face Pain 56:292–305. https://doi.org/10.1111/head.12763
  6. Loder E, Rizzoli P, Golub J (2007) Hormonal Management of Migraine Associated With Menses and the Menopause: A Clinical Review.: CME. Headache 47:329–340. https://doi.org/10.1111/j.1526-4610.2006.00710.x
  7. Seng EK, Singer AB, Metts C, et al (2019) Does Mindfulness‐Based Cognitive Therapy for Migraine Reduce Migraine‐Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial. Headache: The Journal of Head and Face Pain 59:1448–1467. https://doi.org/10.1111/head.13657
Published On: July 5th, 2023