Menopausal Migraines and What to Do About Them

By: Dr. Alyssa Dweck

“Not tonight honey, I have a headache,” takes on an entirely new meaning during peri-menopause and menopause.  Headaches are not at all uncommon with estrogen fluctuations. In fact, headaches are an incredibly common complaint, with a significant percentage of the adult female population affected at some point.  First and foremost, one must ensure there is no significant underlying medical cause of headache. Once that’s firmly established, we can start to consider if hormones are to blame, at least in part.

Many women will attest to a connection between headaches and their hormone status. Many women note a menstrual cyclical recurrence of headaches, starting just before their flow starts, as estrogen levels plummet.  Headaches tend to improve during pregnancy when estrogen levels are high. Headaches may worsen during the peri-menopausal transition when estrogen levels are volatile.  Some theorize that the more abrupt declines in estrogen are in-part to blame for hormonal headaches as menopause approaches. Progesterone decline may also be in play but this association is less clear.

Although hormone therapy can be used to treat vasomotor symptoms, such as hot flashes and night sweats, which are due to falling estrogen levels, no hormonal product is FDA approved to prevent or treat headaches.  Some evidence suggests that phytoestrogens, like black cohosh for example, can either prevent or aggravate headaches, so again, information is conflicting. Sometimes it may take some trial and error to determine the best treatment option for you, but always remember to consult with your physician first. 

Classic migraine headaches are super common and are most common during midlife.  These moderate to severe throbbing headaches are usually experienced on one side of the head and may be associated with nausea, vomiting and light sensitivity. An aura may accompany migraine; flashing lights or wavy lines or even loss of vision or speech may occur.   The presence of an “aura” is particularly important to distinguish since oral contraception, specifically the estrogen component, carries a small increased risk of ischemic stroke in those who suffer from auras.

What does sleep have to do with it?

Interrupted sleep, insufficient sleep or sleeping late might increase the frequency of headaches.  Menopausal women often suffer with one or more of these sleep disturbances.  Up your sleep hygiene game by avoiding caffeine and sugar before bed, limiting screen time before sleep, practicing mindfulness while falling asleep and gaining control of hot flashes and night sweats – you could consider trying a non-hormonal alternative, such as Relizen® which is designed to reduce the frequency and intensity of menopausal hot flashes and night sweats.*

Caffeine helps

Of course this applies to daytime caffeine use.  Many women will find a good cup o’ joe will thwart an oncoming headache. 

Avoid dietary triggers

Red wine, MSG, artificial sweeteners and aged cheeses are common migraine triggers.  If you are prone to headaches, think twice before indulging.

Minimize stress

Regular exercise and stress reduction through mindfulness, meditation or yoga can relieve and prevent tension headaches.  In fact, stress is a common trigger of headache, no matter what your age or hormonal status is.

Multiple treatment options for headache are available including analgesic agents, traditional migraine meds, like Imitrex, and even Botox injections.  When related to hormonal changes, headache prevention is always best.

Alyssa Dweck, MS, MD, FACOG, Bonafide Medical Advisor, is a practicing gynecologist in Westchester County, New York. She provides care to women of all ages and has delivered thousands of babies. A graduate of Barnard College, she has a Master’s Degree in Human Nutrition from Columbia University and her Medical Degree from Hahnemann University School of Medicine in Philadelphia, now named Drexel University. Dr. Dweck currently practices in Mount Kisco, NY and admits to Northern Westchester Hospital in Mount Kisco, NY. She has been voted “Top Doctor” in New York Magazine and in Westchester County and has co-authored three books to date: “The Complete A to Z for your V,” “The Sexual Spark,” and “V is for Vagina.”