Migraines after 40: What’s the link with perimenopause?
Migraines affect around 1 in 7 people and are three times more common in women than men. For many women, migraines can worsen during perimenopause, alongside symptoms such as night sweats, mood swings, and hot flushes. Dr Lowri Bailey, General Practitioner, explains why migraines occur during this stage and how they can be managed.
What can trigger a migraine?
There are many potential migraine triggers, and these can vary significantly from person to person. Common triggers include dehydration, certain foods, skipping meals or fluctuations in blood sugar levels, stress, lack of sleep, caffeine, and alcohol.
Migraines may also have a genetic component and often run in families. Importantly, they are not “just a headache”—they can involve a range of symptoms and may be severe enough to interfere with daily activities, including work and normal functioning.
The oestrogen link
Migraines are strongly linked to fluctuations in hormone levels, particularly drops in oestrogen. This helps explain why many women experience migraines in the days leading up to their period or during the pill-free interval when taking the combined contraceptive pill.
What happens during perimenopause?
Perimenopause is the period leading up to menopause during which hormonal changes begin to occur. During this time, levels of oestrogen and progesterone can fluctuate significantly, often over several years, and most commonly affect women in their 40s.
These hormonal fluctuations can trigger migraines. In addition, other symptoms associated with perimenopause—such as poor sleep, stress, and anxiety—can independently worsen migraine frequency or severity. As a result, many women report an increase in migraine symptoms during this stage of life.
How can migraines be managed during perimenopause?
Lifestyle factors play a key role in managing migraines and can also help improve other perimenopausal symptoms. Helpful strategies include:
Eating a balanced diet with slow-release carbohydrates
Maintaining regular sleep patterns
Exercising regularly
Managing and reducing stress
Reducing caffeine and alcohol intake
Staying well hydrated
Can hormone replacement therapy (HRT) help?
Hormone replacement therapy (HRT) can help stabilise hormone levels and may reduce migraine frequency in some women, particularly where hormonal fluctuations are a key trigger.
Many women believe they cannot take HRT if they experience migraines, especially if they have previously been advised against using the combined contraceptive pill. However, migraine alone is not a contraindication to HRT.
Treatment is typically started at a low dose and increased gradually to avoid sudden hormonal changes. The type and dose of HRT should always be tailored to the individual, taking into account personal and family medical history. Special consideration may be needed for women who experience migraine with aura.
When to seek advice
If you are experiencing migraines during perimenopause, speaking with a GP can help you explore treatment options and develop a management plan tailored to your individual needs.