Migraine and menopause

Hormones, menopause and migraine

We know that migraine and hormones are often closely linked. A drop in levels of the hormone oestrogen is a common trigger for migraine. Periods, menopause, pregnancy and taking the contraceptive pill or HRT may all have an impact on migraine.

Menopause is the stage of life when you stop having periods. You are said to reach menopause when you haven’t had a period for 12 months. The average age of menopause in the UK is 51. This can vary between people from different ethnic groups.

Migraine and perimenopause

Perimenopause is the period of time leading up to menopause. It can last years for some people. As you approach menopause, you can have rapid changes (fluctuations) in your hormone levels. This causes symptoms like irregular periods, hot flushes and night sweats.

These hormone changes can also be a trigger for migraine attacks. It’s common to have more frequent and severe migraine attacks during perimenopause. It’s also possible to develop migraine for the first time during perimenopause.

Migraine after menopause

After menopause, your hormone levels start to settle down as you produce less oestrogen. It’s common for migraine attacks to become less severe and less frequent at this time. They may even disappear altogether. This doesn’t happen immediately, as it can take a few years for your hormones to fully settle down.

Migraine doesn’t always improve after menopause though. You may find your migraine continues, or even gets worse after menopause. This is more likely if your menopause is due to surgery, such as removal of your womb (hysterectomy) or ovaries. If you are considering a hysterectomy for any reason, your doctor can talk to you about the possible effects on your migraine. They can also help you to plan ahead for this.

Managing migraine during menopause

It can be difficult managing your migraine during perimenopause and menopause. If your migraine attacks are usually linked to your periods, they can become more difficult to predict.

Also, menopausal symptoms like hot flushes, night sweats and anxiety can disrupt your sleep and make you feel stressed. This can make you more likely to have a migraine attack. Menopause treatments such as hormone replacement therapy (HRT) can help with this. We have more information on this below.

Keeping a headache diary can help you to see if there is a link between your migraine, your periods and your menopausal symptoms. Show your diary to your GP and ask them how menopausal symptoms may have an impact on your migraine.

Migraine medicines during menopause

You can take acute medicines for migraine, like painkillers and triptans as normal during menopause. But if you are getting more frequent migraine attacks, be careful not to regularly take them on more than two days a week. This can increase your risk of medication overuse headache, when you have more severe or frequent headaches.

If your migraine has got worse during menopause, your doctor might suggest trying a preventive medicine. Talk to your doctor if you are finding acute medicines are not helping or you are using them more often.

If treatment via your GP is not helping, talk to them about a referral to a headache clinic.

Self-help

It can be worth thinking about any lifestyle changes you can make. Many of the lifestyle factors we know to be helpful for migraine can help with menopause symptoms too. These include:

• making sure you have a regular sleep routine
• eating well with regular meals and keeping hydrated
• regular exercise
• maintaining a healthy weight
• managing stress – for example with relaxation or mindfulness techniques
• avoiding or limiting caffeine and alcohol.

Hormone replacement therapy (HRT) and migraine

Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause, such as hot flushes and night sweats. It includes low doses of female hormones, including oestrogen and progestogen. If you have a womb, you will need to take both oestrogen and progestogen. If you have had your womb removed (a hysterectomy), you will only need oestrogen.

HRT comes in different preparations. These include tablets that you take by mouth, and patches, gels and sprays that you apply to your skin. You usually take HRT for a few years. If you’re considering HRT, ask your doctor how it may affect your migraine.

Is HRT safe if I have migraine?

Having migraine, including migraine with aura, does not mean that you can’t take HRT.

If you have migraine with aura, you should not take the combined oral contraceptive pill. This is due to an increased risk of stroke with this medication. But it’s not the same with HRT. HRT includes a different form of oestrogen, and a much lower dose than the contraceptive pill. This means the risk of stroke is much lower.

There can be certain other risks of taking HRT for some people. But for the majority, the benefits of taking short-term HRT outweigh any risks. Your doctor will discuss the potential benefits and risks with you before prescribing HRT.

Will HRT help with migraine?

Some people find that HRT can help with their migraine. This is due to its effects on reducing menopause symptoms. But others find HRT makes their migraine worse.

Your doctor will usually recommend HRT patches, gel or sprays rather than tablets if you have migraine. This is because these preparations provide more stable hormone levels than tablets. That means they are less likely to trigger migraine attacks. They will also prescribe the lowest possible dose of oestrogen to control your menopause symptoms.

If you need to take progestogen, your doctor may recommend one of the following:

• a patch that contains both oestrogen and progestogen
• the intrauterine system (IUS) or hormonal coil, that is placed in your womb
• micronised progesterone, a form of progestogen identical to the hormone your body produces.

If you find that HRT makes your migraine worse, speak to your doctor. They can review the dose and type of HRT you are taking. There are many different types of HRT, and it can take time to find the best one for you.

Other treatments for menopause

There are other treatments that can help with symptoms of menopause. Some of these you may be able to use as well as HRT. Others can be used as an alternative if you can’t or don’t want to take HRT.

Contraceptive pill

You may be able to take the combined oral contraceptive pill as an alternative to HRT to help with menopause symptoms. You can take the combined oral contraceptive pill until you’re 50. You can’t take it if you have migraine with aura.

Non-hormonal medicines

There are certain medicines that can help with both migraine and menopause symptoms. These include the following.

• Antidepressant medicines, like venlafaxine and escitalopram.
• Clonidine – a medicine usually used for high blood pressure.

Your doctor may prescribe these, depending on what symptoms you have.

Vaginal preparations

Creams and tablets containing oestrogen can help with vaginal dryness and discomfort. You insert these into your vagina. The oestrogen is not absorbed into your bloodstream, so they won’t affect your migraine.

You can also get vaginal moisturisers and lubricants that don’t contain oestrogen.

Useful organisations

• Women’s Health Concern
  womens-health-concern.org
• The Menopause Charity
  themenopausecharity.org

About our information

This information has been written by The Migraine Trust Information and Support Services team. It has been reviewed by our panel of expert health professionals and people affected by migraine.

Our information has been awarded the PIF TICK quality mark for trustworthy health information.

If you have feedback on our information, please get in touch at: feedback@migrainetrust.org

References for our information are available on request.

Last reviewed: March 2025 | Next review due: March 2028