Migraines worsen in perimenopause
Menopause often brings relief to female migraine sufferers. However, many women have worsening of their migraines during the transition. This is thought to be due to the fluctuating levels of estrogen, which is also responsible for menstrual migraines. Steady levels of estrogen during pregnancy and in menopause lead to a dramatic relief of migraines in two out of three women.
A study published in a recent issue of the journal Headache examined the relationship of headache frequency to the stages of menopause. The study looked at 3446 women with migraines with a mean age of 46. Among women who were premenopausal, 8% had high frequency of headaches (10 or more headache days each month), while during perimenopause as well as menopause, 12% of women had high frequency of migraines. This does not contradict the fact that many women stop having migraines in menopause, but it suggests that among those women who continue having migraines, there are more with high frequency of attacks.
By publishing these findings, the authors wanted to draw attention to the fact that many women may need a more aggressive approach to treatment. In women with high frequency of attacks preventive therapies tend to be more effective than abortive ones. These may include magnesium, CoQ10, Boswellia, and other supplements, as well as preventive medications and Botox injections. At the same time, most women may also need to take abortive therapies, such as triptans.
Progesterone plays a much smaller role than estrogen. Over the years, I have seen a handful of patients whose migraines got worse from progesterone.
Hi Dr. Mauskop,
With HRT, the role of estrogen in migraines is clearer than the role of progesterone in migraines. Is a higher dose of progesterone along with the estrogen more effective in migraine reduction, or does progesterone not play as big a role in migraines as estrogen does? As always, thank you.
Not all women stop having migraines after menopause. About two-thirds do. Migraines can get worse during the transition into menopause. HRT can help during this transition. In a minority of women, HRT does make their headaches worse.
You mention that menopause often brings relief from migraines. Is that true even if women take HRT medications?
Yes, HRT sometimes helps even out the fluctuations of estrogen levels and improves migraines. In younger patients, continuous contraception sometimes produces similar results.
Hi again. I’ve now tried amitryptiline, nortryptiline, botox twice, and Emgality since July 1st…still having 15 or more migraines per month. Thankfully Imitrex works very well. My neurologist wants me to try topiramate but I’m reluctant given the side effects. Do you ever recommend trying HRT? Thank you!
Yes, hormonal changes can do it, but Botox can be very effective.
Hi Dr. Mauskop. I’m a 49 year old woman and I’ve had migraines since I was a teen, but only every few months and usually relieved with ibuprofen/Tylenol and Coca Cola. The past 18 months they have increased to 1-2 per month and the past 3 months they have increased to 10-12 per month! And the ibuprofen/Tylenol and Coke combo isn’t working. I have been on low dose continuous estrogen BCP for the past 7 years and decided to try stopping this a few weeks ago. I have been having a migraine daily the past 8 days. I received a Rx for sumatriptan this month and it is working well but I have to take 100mg daily and sometimes twice a day. I have started Mg, B2, coenzyme q10 this month and started melatonin 3 months ago. Is it normal for my migraines to have increased to such frequency in such a short amount of time as a result of perimenopause? Any other suggestions? I am waiting to see a neurologist to ask for Botox… Thank you for this blog!