Migraine and menopause
Shifting hormones, mood changes, stress, lack of sleep: these are all factors that can trigger or exacerbate migraine headaches. This can make menopause a pain to navigate – literally. It is estimated than one in three women suffer from migraine attacks in the years leading up to menopause. Women who suffered from migraines before menopause may find they are worse, and those who have never had them before might start getting them.
I’ve had migraine headaches for years, but since I hit menopause they've become worse. Is there anything I can do to stop these attacks? - Irma (age 45)
Women are three to four times more likely than men to have migraine. But why? Hormonal fluctuations during menstruation, pregnancy and menopause make women more susceptible to these severe headaches.
In general, migraine headaches are more common during perimenopause, the phase before menopause. This is when hormonal fluctuations are most erratic. Most women get fewer migraines (or they may disappear altogether) once their periods stop and their bodies get used to the new balance of sex hormones.
What is happening in your body?
It is known that hormonal imbalances during perimenopause and menopause (and during menstrual cycles) make women more susceptible to migraines. This is due to fluctuating oestrogen levels. More specifically: a sudden drop or rise in oestrogen in comparison to progesterone.
The brain and the ovaries are in a state of continuous communication. This ovarian-brain feedback loop is essential for regulating physiological functions. When this loop gets disrupted due to hormonal fluctuations, the pituitary gland (a small hormone-secreting gland located at the base of the brain) releases extra follicle stimulating hormone (FSH) to the ovaries. This can trigger or exacerbate migraine headaches, especially in women who are already prone to them.
Other causes
There are also contributory factors (which may or may not be menopause related) that can act as triggers or worsen migraine headaches, like stress, anxiety, lack of sleep, hot flashes, night sweats and changes in menstrual pattern. Certain medications or underlying health conditions can also cause migraine.
Migraine vs headache
We all have headaches from time to time. A headache is just that, an ache in the head. But migraine is more than an ache in the head. Migraine is a condition in which you get severe recurring headaches that disrupt your everyday life.
The symptoms of migraine include a pounding or throbbing pain, brief jolts of stabbing pain, nausea, and oversensitivity to light, sound and/or smell. Migraine attacks can last from a few hours up to several days.
Some women have migraine with aura symptoms: visual disturbances such as flashing lights or shimmering spots. Sometimes these flashes of lights get bigger, or they can be accompanied by numbness, typically felt as tingling in one hand that may spread slowly along a limb.
If you suffer from severe or persistent headaches, you should see your GP to rule out another health condition, especially if you are a smoker.
What can you do?
The following factors are known to help with migraine symptoms:
- A healthy intestinal flora. Research has shown that overgrowth of bad gut bacteria plays a role in the development of migraine. You can improve your intestinal flora by eating plenty of fibre-rich foods, fruit and vegetables. Prebiotics and probiotics can also benefit digestive health.
- Get enough omega-3. Omega-3 has an anti-inflammatory effect. Eating a diet rich in omega-3 fatty acids can reduce the frequency and severity of migraines. Omega-3 is found in chia seeds, walnuts, flaxseed oil and oily fish. If you aren’t getting enough omega-3, then consider taking a dietary supplement.
- Get enough magnesium. A lack of magnesium can cause or exacerbate migraine headaches. Eat plenty of magnesium-rich foods (such as vegetables, nuts, peanuts and whole grain products) or consider taking a supplement if necessary.
- Get enough of rest and relaxation. A busy lifestyle and stress can trigger migraine headaches or make them worse. Incorporate moments of quiet into your daily routine and try to limit stress in your life. It doesn’t have to lake long. Doing a breathing exercise for a few minutes can also be effective. Is your schedule overloaded with activities? Accept that you can't do everything. Try to prioritise your commitments and learn to say 'no' sometimes.
- Do you have severe or persistent migraine? See your GP to rule out other causes.
Medication for menopausal problems
Migraines can turn your life upside down, or better put: they can put your life on hold. Thankfully, there are treatments available for menopausal symptoms.
What treatments can help?
Do you take aspirin or paracetamol for your headaches? For some types of headaches, like migraine, that's not an effective approach. If you suffer from migraine as well as other severe menopausal symptoms, then HRT might be an option for you.
Can hormone therapy help?
Hormone replacement therapy (HRT) can make a huge difference to a woman's quality of life and well-being during menopause. HRT works by replacing the hormones that fall during and after menopause, which helps to improve severe symptoms. HRT is used to treat symptoms such as hot flashes, sleep problems, vaginal dryness and mental health symptoms. It is not a first-line treatment for migraine. However, if you're also suffering from other symptoms besides migraine, then hormone therapy might be an option for you.
Sources
- Silberstein SD. (2000). Sex hormones and headache. PMID: 11139745.
- Rossi MF, Tumminello A, Marconi M, Gualano MR, Santoro PE, Malorni W, Moscato U. (2022). Sex and gender differences in migraines: a narrative review. PMID: 35676560.
- Soveyd N, Abdolahi M, Bitarafan S, Tafakhori A, Sarraf P, Togha M, Okhovat AA, Hatami M, Sedighiyan M, Djalali M, Mohammadzadeh Honarvar N. (2017). Molecular mechanisms of omega-3 fatty acids in the migraine headache. PMID: 29736227.
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FAQ
How long will I keep getting hormonal migraines?
Migraine headaches tend to worsen in the years leading up to menopause, particularly in women who already suffer from them. The main reason for this is the fluctuation of oestrogen. As periods become less frequent, migraines usually lessen or go away entirely. This may take two or three years after your last period, as it can take this long for your hormones to stabilise.
