Increased Risk for Headaches as Migraineurs Near Menopause

Effect of Perimenopause on Your Risk for Headache Attacks

Middle aged woman with a headache
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For many women, perimenopause may be an overwhelming time filled with irregular menstrual cycles, hot flashes, vaginal dryness, mood disturbances, and difficulty sleeping.

In addition, this seemingly daunting time may be worse for migraineurs and their headache attacks. According to a 2016 study in Headache, migraineurs' risk for developing high frequency headaches in perimenopause — defined as having 10 or more headaches per month — was greater, when compared to premenopausal women with migraines.

What Is Perimenopause?

Perimenopause is the period of time just prior to menopause. For most women, they enter perimenopause in their 40s —  the average age being 47 — and reach menopause in approximately four years. Early perimenopause is characterized by fluctuating estrogen levels and shorter menstrual cycles. As women progress into late perimenopause, estrogen levels start declining, and they develop more menstrual irregularities, in addition to symptoms like hot flashes and vaginal dryness. When a woman stops menstruating for one year (menopause), this is a signal that her ovaries have stopped producing estrogen.

Why an Increased Risk of High-Frequency Headaches During Perimenopause?

A precise explanation for why migraineurs are more likely to experience high-frequency headaches during perimenopause is unclear. Experts suspect that hormonal changes that occur during perimenopause — specifically the decline in estrogen — may be an explanation. This estrogen decline is linked to a decline of serotonin in the brain, which activates the trigeminal pain system, causing a migraine.

In addition, women in perimenopause often have heavier menstrual flow (more bleeding) during their menstrual periods, which can cause iron deficiency. This too may trigger migraines.

Also, heavy menstrual flow is linked to an increased prostaglandin release in the body. Prostaglandins are involved in a number of processes, including allowing the uterine lining to shed, as well as potentially triggering migraines.

Do Headaches Improve After Menopause?

Scientific studies are conflicting as to whether headaches, especially migraines, improve when a woman is postmenopausal, meaning when she has not had a menstrual cycle for 12 months.

Experts suggest that the conflicting studies (meaning some show migraines improve after menopause and others show they worsen) imply that other factors determine the likelihood of migraines after menopause. For example, having depression may increase a woman's risk of having more migraines. Also, using pain-alleviating medications to relieve menopause-related symptoms like muscle or joint pain could trigger a type of headache in menopause called a medication-overuse headache.

Treating Your Headache Attacks

The good news is that there are therapies to help you if you notice more headache attacks as you near menopause. For instance, adapting healthy sleep habits, eating well, daily exercise, and stress management may be helpful for your headaches and will also improve your overall health. In addition, your doctor may consider a headache preventive medication.

Also, menopausal hormonal therapy may be used during perimenopause or early menopause to relieve hot flashes and vaginal atrophy, and they may have the added bonus of reducing migraines. While hormone therapy can do wonders for some women, it does carry some health risks, and may not be appropriate for you based on your medical history. A thoughtful conversation is needed with your personal physician before this can be prescribed.

Bottom Line

Perimenopause is a hallmark period of time that signals a decline in estrogen in a woman's body. While the physical and mental changes that occur for women may be anxiety-provoking, please know that you are not alone. Thousands of other women are experiencing perimenopause at the same time as you. Remember too, perimenpause and menopause are not health conditions, but rather stages of reproductive aging — or rather parts of the journey of being a woman.

If you believe you are nearing menopause, please visit your doctor for a consultation on how you can manage your symptoms (including headaches and other menopausal-related symptoms like hot flashes). Your doctor can also provide information on how to best care for your body, especially your heart and bones, which can be affected by the hormonal and age-related changes of menopause.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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