Can menopause cause headaches and migraines?

Most women experience headaches at some point in their lives. But if you’re going through the menopause transition and your headaches or migraines are getting worse or more frequent, changing levels of reproductive hormones like oestrogen could be the culprit.

In many cases, these headaches are made worse by increased stress, which is also a common feature of menopause.

In this article, we’ll explore the link between menopause, headaches and migraines, look at the specific symptoms you might experience and explain the different treatments and lifestyle changes that could help.

The link between menopause and headaches

Changing hormone levels during the menopause transition can contribute to headaches. They may become more frequent and more severe, or you might start to experience them on a regular basis for the first time.

The most common types of menopausal headaches are tension headaches and migraines.

• Tension headaches: Like a tight band around your head. May also affect your face and neck.
• Migraines: Painful throbbing on one side of your head, sometimes accompanied by sensitivity to light or feeling sick. May start with an ‘aura’, involving visuals like zigzag lines or flashing lights, dizziness, pins and needles or difficulty speaking.

Hormone-related headaches are not only a feature of menopause – many women get migraines or headaches before or during their periods, as their oestrogen levels drop. But during perimenopause – the years leading up to menopause – oestrogen fluctuates more than usual, which is why headaches or migraines can get even worse.

One survey of 1,000 women who attended menopause clinics, found that 85% reported recurring headaches, almost a quarter experienced migraines and over 25% had a particular sensitivity to the hormone changes that can cause these symptoms.

The study also found that stress and anxiety – themselves symptoms of perimenopause and menopause – were the most common triggers for headaches.

Although there’s clearly a link between menopausal hormone changes and headaches, there’s still a lot scientists don’t understand. Some women actually see an improvement in their symptoms during perimenopause, particularly those with aura migraines.

And while migraines often improve or even disappear after menopause, when your periods have stopped and oestrogen levels settle at their lowest point, tension headaches sometimes get worse.

It may be that menopausal migraines are most influenced by fluctuations in oestrogen, while tension headaches are more closely linked to low levels – but more research is needed to support this.

What does a menopause headache feel like?

As we’ve seen, menopause headaches tend to come in two main types.

Tension headaches feel like a band of pressure around your head. They may also involve neck pain and the affected areas may feel tender to the touch.

Migraines tend to involve a throbbing pain on one side of your head, and may be accompanied by nausea, sensitivity to light and ‘aura’ symptoms, like flashes or zigzags in your visual field or a feeling of pins and needles.

Some women also report ‘ocular migraines’ – also known as ‘retinal migraines’ – where they experience a temporary loss of vision in one eye.

The timing of menopause headaches can vary but some women experience them more often in the morning when they wake up, or at night.

If you’re not sure whether your headaches are menopause-related it can be helpful to keep a headache diary. Note down when you get headaches, as well as the timing of menopausal symptoms like hot flushes. This can help a doctor to decide if there’s a link between the two.

Treatments for menopause headaches

Here we’ll look at some of the approaches that can help to manage the symptoms of headaches and migraines, from medication to lifestyle changes.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) replenishes reproductive hormones such as oestrogen and progesterone lost during perimenopause or after menopause.

HRT can improve menopausal migraine symptoms for many women – but you may also find it makes your migraines worse. If that’s the case, your doctor may change the dosage or suggest a different form of HRT.

While there’s less direct evidence that HRT can reduce tension headaches, it may help some women. It can also be effective in improving other menopause symptoms, such as stress, anxiety and poor sleep, which can contribute to tension headaches.

HRT comes in a number of forms but if your doctor suggests trying it to help with your migraines they will usually recommend patches, gels or sprays rather than tablets. These keep your hormones at a more constant level, avoiding the fluctuations that may contribute to migraines.

If you have other menopause symptoms, such as hot flushes, your doctor may use these as a guide to how much oestrogen to prescribe. They’ll generally try to prescribe the lowest dose that controls those symptoms. Unless you’ve had your womb removed – a hysterectomy – your HRT should also include progesterone.

You may have heard that you shouldn’t take HRT if you get aura migraines, but UK health charities the British Menopause Society and The Migraine Trust agree that this is not the case. It’s true that taking the combined contraceptive pill, which also contains oestrogen, can increase your risk of stroke if you get aura migraines. But HRT uses a different form of oestrogen at much lower levels, and is considered safe.

Other medication

If you’re looking for quick relief from a headache, over-the-counter painkillers like paracetamol, ibuprofen and aspirin can help with both migraines and tension headaches during perimenopause and after menopause.

If you get migraines, your doctor may prescribe triptans, which work by reducing the transmission of pain signals from particular receptors in your brain. They’re most effective if you take them as soon as your headache starts.

Although these drugs can be helpful when used from time to time, it’s important not to take them too often – more than twice a week – as this can actually make your headaches worse or more frequent.

Doctors may sometimes prescribe drugs used to treat anxiety or depression, such as escitalopram and venlafaxine, to help with menopause symptoms including migraines.

Lifestyle changes

These key health pillars can all help to improve both headaches and other menopause symptoms, as well as boosting your overall health.

• Get regular exercise: Studies suggest that women who do more physical activity have less severe menopause symptoms – and there’s evidence that regular exercise can help specifically with both migraines and tension headaches. The Migraine Trust recommends a combination of aerobic and muscle-strengthening exercise, but warns that intense workouts can trigger migraines in some people.
• Improve your sleep habits: Poor sleep, anxiety and stress are an interlinked group of menopause symptoms that together can make migraines and tension headaches worse. To increase your chances of a good night’s sleep, follow these tips for improving your bedtime routine. If you get neck pain with your headaches, try switching to a low, firm pillow.
• Try other activities to reduce stress: Stress is one of the main triggers of migraines and headaches. Both regular exercise and getting better sleep can help to reduce stress, but you may also want to try other activities that help relax your mind and body, like yoga, meditation and massage.

When to see a doctor

The NHS advises contacting your GP if:

• you get headaches several times a week or migraines more than once a week
• your headaches or migraines are severe or getting worse
• you regularly get migraines before or during your period
• painkillers and stress relief are not helping
• you have a throbbing pain on one side of your head or at the front
• you also feel sick and find light or noise painful
• HRT is making your migraines worse

Probiotics for menopause symptoms

Probiotics are friendly bacteria that can boost your gut health, leading to benefits all around your body.

But all probiotics are not created equal. The probiotic strains in Better Gut have been specially chosen to improve the functioning of your estrobolome, the part of your gut microbiome that processes oestrogen, meaning fewer hormonal highs and lows.

These probiotic strains have been shown in studies to help with menopause symptoms including:

• hot flushes
• poor sleep
• anxiety
• brain fog
• bloating and constipation

Summary

Changing levels of the reproductive hormone oestrogen can contribute to both tension headaches and migraines during the menopause transition.

Migraines are often at their worst during perimenopause when oestrogen levels are fluctuating, and may get better after menopause when oestrogen settles at its lowest point. But that’s not true for everyone.

Tension headaches can continue to get worse even after menopause but, again, symptoms follow different patterns for different women.

The varied effects of these hormone changes are also seen when it comes to hormone replacement therapy. HRT can improve both migraines and tension headaches for many women but may sometimes make them worse. In these cases, adjusting the type of HRT, or the dosage, may help.

Over-the-counter painkillers can provide relief from a tension headache or migraine, while triptans, prescribed by a doctor, can help with migraines. But taking these medications more than twice a week could make symptoms worse.

Getting regular exercise, improving your sleep habits and doing relaxation techniques could all help to relieve stress and improve menopause symptoms including headaches and migraines.

If you have headaches or migraines every week, or if they’re severe or getting worse, you should see a doctor.