Can Headaches Be a Symptom of Anemia?

Migraines, headaches, and pain have been associated with iron deficiency anemia (low iron levels in the blood).Since iron is a nutrient that your body doesn't produce on its own, low levels can be due to a lack of iron in your diet but there are other causes, like pregnancy or blood loss.

While the tendency to experience migraines may be partially genetic, low-iron anemia, especially near the end of a menstrual period, is a common reason for headaches. But other factors that can lead to headaches include infections, stress, and lifestyle factors like your diet.

This article discusses why headaches can be a symptom of anemia as well as other potential causes of headaches. It explains how anemia-related headaches are treated and when a healthcare provider can help.

iron deficiency anemia and menstrual migraines

Verywell / Laura Porter

Causes of Iron Deficiency Anemia

Iron is an essential mineral that we get from food, especially red meat, spinach, and iron-fortified cereals and breads. Deficiencies may arise from your diet, from bleeding, or other causes. These include pregnancy, which increases the body's iron demand, or certain diseases that interfere with absorption, such as celiac disease, chronic diarrhea, and other digestive problems.

What Are Migraines?

Migraines are attacks of severe headaches and other symptoms that last anywhere from hours to several days. Symptoms of migraine headaches include:

  • Headaches: Migraine headaches are moderate to severe in intensity, described as throbbing or severe, and often localized on one side of the head. The pain can also move around and can last up to 72 hours.
  • Sensitivity to light, sounds, or certain smells: These stimuli can make migraines worse or prolong their duration.
  • Nausea: Feeling nauseated, vomiting, or both are also frequent symptoms, often occurring when the headaches are at their worst.
  • Physical weakness: Muscle weakness and fatigue can be symptoms of attacks. Some people experience temporary paralysis on one side of the body.
  • Aura: Some people have what’s called migraine with aura. In these cases, headache attacks are preceded or accompanied by visual disturbances, temporary blindness in one eye, seeing flashing lights or lines, numbness or tingling on the skin, ringing in the ears, and changes in speech patterns.   

Migraines can also cause double vision, dizziness, and changes in your sense of smell or taste. Some people experience elation, depression, restlessness, or sleep disturbances due to the condition.

Is Migraine a Symptom of Iron Deficiency Anemia?

Iron deficiency anemia has been linked to migraines, headaches, and an increased predisposition to pain. It also can cause a variety of symptoms, including fatigue, dizziness, anxiety, and depression.

When you have less-than-optimal oxygen delivery throughout your body, this can cause generalized physical symptoms. It may exhaust you mentally and physically.

There are several possible reasons for why low-iron anemia can lead to headaches, including:

Menstrual Migraines

Menstrual migraines affect approximately half of women who experience migraines. While the precise cause of these recurrent migraine attacks has never been fully understood, most experts agree that the decline in estrogen that occurs prior to menstruation plays a big role in this complex phenomenon.

Iron deficiency anemia from the acute blood loss of menstruation may also play a role in menstrual migraines, especially when they occur near the end of a woman's period. Some have classified this end-of-menstruation migraine as a unique type of migraine.

A combination of factors, including estrogen depletion, iron deficiency anemia, and altered serotonin levels can all lead to the development of menstrual migraines.

Decline in estrogen levels is believed to cause migraines right before or during the early days of a woman's period, whereas iron deficiency anemia has been proposed to be a potential trigger of migraines that occur during the last few days of a woman's period.

Idiopathic Intracranial Hypertension

Iron deficiency anemia is considered a risk factor for developing idiopathic intracranial hypertension (IIH), a relatively rare disorder that tends to affect people with obesity and females in their childbearing years.It's caused by increased spinal fluid pressure around the brain.

It's common for people with an IIH diagnosis to experience headaches along with other classic symptoms, including:

  • Papilledema, a type of swelling in the eye caused by increased pressure on the brain
  • Pulsatile tinnitus (hearing a pulsating or throbbing noise in your head)
  • Nausea and vomiting

IIH is a treatable condition, but it's important to get diagnosis and treatment early in order to avoid permanent vision loss.

Pregnancy

Migraines are common during pregnancy, just as they often occur during your menstrual cycle. They are the most common type of headache found with hormonal changes, especially estrogen.

Migraines may be related to low-iron anemia during pregnancy because of the increased demand for iron, but the anemia risk is typically temporary. The anemia can be addressed with prenatal iron supplements.

While most pregnant people are not at serious health risk from low-iron anemia, it can affect the developing fetus. Migraines, however, can signal an increased risk of developing high blood pressure (hypertension) during pregnancy, which can lead to complications.

Treatment and Management of Headache

In general, migraines that are associated with iron deficiency anemia are less severe and easier to treat than migraines associated with alterations in estrogen levels. Migraine treatment can include over-the-counter pain medications or prescriptions, including triptans like Axert (almotriptan).

If you have iron deficiency anemia, treating this underlying problem is important for your overall health and can possibly help prevent menstrual migraines from recurring.

Iron supplements can restore your red blood cell function, but they can also cause side effects, including severe constipation. Be sure to check with your healthcare provider before taking any supplements.

When to See Your Healthcare Provider

Low-iron anemia can have a common and easily treatable cause. Changes to your diet, for example, can help to boost iron levels when including lean meat, seafood, and other iron-rich sources. But anemia also can be a sign of cancer or its treatments, as well as other serious conditions.

See your healthcare provider about an anemia diagnosis if you have chronic fatigue symptoms or experience:

  • Headaches that don't go away or worsen
  • Shortness of breath
  • Dizziness
  • Mouth sores

Severe headaches also can be the sign of a serious condition, such as a tumor, stroke, or a meningitis infection. Seek immediate medical attention or call 911 if you experience a headache along with:

  • A sudden, severe onset
  • Fever
  • Seizures
  • Neck stiffness
  • Mental confusion
  • Weakness or numbness

Summary

Headaches can be a sign of low-iron anemia, which reduces your body's ability to carry enough oxygen to meet its needs. The anemia can be caused by a number of conditions, from iron deficiencies in your diet, pregnancy, or cancer.

Menstrual migraines are sometimes associated with low-iron anemia at the end of your period. Other conditions, including idiopathic intracranial hypertension, also have been linked to anemia and headache.

Most headaches won't be serious but it's important to get an accurate diagnosis if your symptoms don't go away. Once your healthcare provider has determined the cause, treatment of your anemia and/or headache will depend on this diagnosis.

A Word From Verywell

Migraines generally recur regularly, and they can affect males and females. If you are prone to migraines, episodes of blood loss or nutritional issues could cause you to have more migraines than usual. Be sure to discuss any changes in your migraine pattern with your healthcare provider.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gür-Özmen S, Karahan-Özcan R. Iron deficiency anemia is associated with menstrual migraine: a case–control studyPain Medicine. 2016 Mar;17(3):596-605. doi:10.1093/pm/pnv029

  2. MedlinePlus. Migraine.

  3. Miller JL. Iron deficiency anemia: a common and curable diseaseCold Spring Harb Perspect Med. 2013;3(7):10.1101/cshperspect.a011866 a011866. doi:10.1101/cshperspect.a011866

  4. Pamuk GE, Top MŞ, Uyanık MŞ, et al. Is iron-deficiency anemia associated with migraine? Is there a role for anxiety and depression? Wiener klinische Wochenschrift. 2015;128(S8):576-580. doi:10.1007/s00508-015-0740-8

  5. Ma Z, Jiang H, Meng C, Cui S, Peng J, Wang J. Idiopathic intracranial hypertension in patients with anemia: A retrospective observational study. PLoS One. 2020 Jul 31;15(7):e0236828. doi:10.1371/journal.pone.0236828.

  6. UpToDate. Estrogen-associated migraine.

  7. Rahmati S, Azami M, Badfar G, Parizad N, Sayehmiri K. The relationship between maternal anemia during pregnancy with preterm birth: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020 Aug;33(15):2679-2689. doi:10.1080/14767058.2018.1555811.

  8. National Headache Foundation. Facts About Triptans.

  9. Penn Medicine. What Is Anemia?

  10. Phu Do T, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 listNeurology. 2019;92(3):134-144. doi:10.1212/WNL.0000000000006697

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.