Migraines are among the most debilitating conditions in the world, affecting 38 million people in the United States alone. They're also three times more likely to affect women than men, which means migraines are affecting over 25 million American women. But what is the connection between migraines and menopause?
While there is no doubt that hormones play a role in migraines, it is still unclear exactly what role they play. Some women feel better after going on birth control, but others feel worse. Some women find relief after entering menopause, while for some women, the worst is yet to come.
So what is with the variability? This article is going to dive into migraine during menopause and why women can feel better, worse, or it can just be the beginning. We'll also explore how lifestyle, nutrition, and medical options, including hormone replacement therapy (HRT), can play a role in relief.
Key Takeaways :
Hormonal Changes & Migraines: Rapid hormonal decline, fluctuation of estrogen, and increased neuroinflammation during menopause can trigger migraines.
Prevalence After Menopause: Up to 29% of women still experience migraines after menopause.
Perimenopause and Migraines: Hormonal changes, hot flashes, and sleep disruption can increase migraine frequency and severity, but new treatments offer relief.
Inflammation: Hormonal drops cause inflammation, worsening migraine severity and frequency.
Hormonal Imbalance: Imbalances during perimenopause can exacerbate migraines; testing helps manage them.
Neurological Impact: Inflammation and hormones affect the nervous system, increasing migraine sensitivity.
The Hormone Situation
So what is it with hormones? The good news is, sometimes migraines can be caused by too much estrogen, so heading into menopause may be the best thing that ever happened to your migraines. But what if that's not the case? Menopause means many different changes throughout the entire body, but the big thing that happens is a rapid decrease in hormones. Now it's not so much the decrease in hormones that can cause the issue; in fact, that is what is supposed to happen when a woman enters menopause. It's the RAPID decrease (keyword being rapid) that causes our bodies to freak out a little bit. A rapid decrease in hormones causes a surge of inflammatory substances, many of which have a large effect on the brain. These inflammatory substances can make our brain more sensitive to our environment, leading to light and sound sensitivity, nausea, fatigue, brain fog, and migraines.
Migraine Frequency in Menopause
Migraine frequency in menopause tends to decrease, so why are so many menopausal women suffering from migraines? A study done by Delaruelle in 2018 found "migraine prevalence declines after menopause compared to the fertile period. However, the prevalence of migraine after the menopause is still 10 to 29% across studies".
That means up to almost 30% of women are still suffering from migraines after they hit menopause. This hormonal turbulence can also interact with other known migraine triggers, like disrupted sleep, increased stress, and changes in diet, making midlife migraine patterns unpredictable.
Research suggests that women with a history of menstrual migraines are more likely to continue experiencing attacks after menopause, especially during the perimenopausal transition. Additionally, fluctuating estrogen, common in early menopause, can keep the brain’s pain pathways in a hypersensitive state, prolonging the migraine window.
Migraines and Perimenopause
As women transition into perimenopause, the hormonal fluctuations, especially the changes in estrogen levels, can have a significant impact on migraines. For many, migraine frequency and intensity can increase, even if they’ve been stable in the past. Estrogen fluctuations affect brain sensitivity, making the body more vulnerable to migraines. Added symptoms of perimenopause, like hot flashes, insomnia, and heavy menstrual bleeding, can also lower the migraine threshold, leading to more frequent attacks. Disrupted sleep and iron deficiency from heavy bleeding can make migraines even worse. For some women, perimenopause may bring the first signs of migraines, while others may experience a worsening of existing symptoms. If this sounds familiar, it’s important to reach out to a healthcare provider. With the right care, including new treatments like gepants and neuromodulation devices, relief is possible.
What Can Be Done About Menopausal Migraines?
There are many things that menopausal women should know about migraines. Here are just a few:
1. Inflammation
Inflammation is a major source of problems for all women during menopause, not only those who have migraines. A woman's body is supposed to adapt to the rapid drop in hormones during perimenopause, but when it cannot, we get a bunch of body-wide inflammation. This is one mechanism that can potentially increase the prevalence of migraine in women during menopause.
Addressing this inflammation can not only lessen migraine severity and frequency but can also help with other menopausal symptoms as well! Sometimes inflammation like this can be seen on testing, but sometimes it cannot. However, whenever we have a sudden drop in hormones, inflammation is inevitable and must be addressed promptly.
Anti-inflammatory strategies can include adopting a diet rich in omega-3 fatty acids, colorful vegetables, and low-glycemic carbohydrates; engaging in regular moderate exercise; and ensuring adequate vitamin D levels. Certain supplements, such as magnesium glycinate and riboflavin (vitamin B2), have also been linked in studies to reduced migraine frequency.
2. Hormone Imbalance
Hormone imbalances are a problem for women of all ages, but going into menopause with a hormonal imbalance can cause real issues. When we reach perimenopause and our hormones begin to drop, our adrenal glands are supposed to take over and produce the little hormones our body still needs. If our adrenal glands can't handle the new responsibility (whether due to subclinical infection, stress, thyroid issues, etc.), we see even more of a hormonal problem.
The best and most thorough hormonal panel that can be run is called a DUTCH test. Running a DUTCH test will give us accurate hormone levels, along with how well your body is detoxifying hormones. With this information, we can accurately manage hormonal levels and, in turn, help decrease migraines. In some cases, carefully monitored hormone replacement therapy (HRT) can help smooth hormonal fluctuations and reduce migraine frequency, especially in women whose symptoms are clearly tied to fluctuations in estrogen. However, HRT is not suitable for everyone and should be discussed in depth with a healthcare provider.
3. Neurological Changes
One major system that hormones and inflammation can affect is the nervous system. Our sex hormones even have neuro-equivalents in our brains! Inflammation can break down the blood-brain barrier and let bad things through, leading to more inflammation in the brain. This can cause an increase in migraine severity and frequency because our brain becomes more sensitive (see our blog called "Trigger Happy – Why 'Triggers' Are Not Causing Your Migraines")
Lifestyle and Self-Care Strategies for Migraines in Menopause
While medical evaluation is crucial, self-care steps can make a noticeable difference. Maintaining regular sleep patterns, staying hydrated, managing stress with relaxation techniques (yoga, meditation, deep breathing), and tracking potential triggers in a migraine diary can all help reduce attack frequency. Limiting caffeine and alcohol, particularly red wine, may also help in sensitive individuals.
A migraine diary is especially valuable during menopause, as it can help identify whether attacks correlate with hot flashes, poor sleep, stress spikes, or dietary choices. Armed with this data, you and your clinician can make more targeted changes.
Ready to support your hormones? We can help
Addressing the underlying cause of migraine is one of the most important things we do. After that, managing other bodily systems involved is equally important. Doing a thorough history, combined with the proper advanced testing, can provide the answers you need to manage your migraines properly.
Our functional medicine approach means we don’t just manage symptoms, we look at hormone health, inflammation levels, nutrient status, and nervous system resilience. This comprehensive view is particularly important in menopause, when multiple systems are changing at once.
If migraines and hormonal imbalance are impacting your well-being, the first step is clarity. At Restorative Health Solutions, we use comprehensive testing and personalized strategies to help uncover what’s really happening. Schedule a consultation today to explore how we can help you support your health.
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