Can Headaches Be a Symptom of Menopause?

Menopause and headaches are often intertwined. For some women, menopause marks the end of monthly hormonal headaches. But, the transition into menopause can trigger more frequent headaches and migraines.

This article discusses menopause and headaches. It also explains how shifting hormones cause different types of headaches related to menopause. This article also provides ways to find relief from hormonal headaches and possibly even prevent headaches and migraines during menopause.

What Are Headaches and Migraines?

A headache is mild to moderate pain in the head or face area, usually on both sides of the head. Tension headaches are the most common type. Tension headache pain is often described as dull or like a tight band wrapped around the head. Sometimes, the pain may affect the neck or the back of the head. Headache discomfort may last a few hours to a few days.

A migraine is moderate to severe headache that is often described as throbbing or pounding. The pain is usually on one side of the head, but can also affect the face and neck. Migraines often come with nausea as well as sensitivity to light, smells, and sounds. Migraines commonly last for a few days and can be followed by exhaustion or brain fog.

Up to 25% of people experience what's known as a migraine aura leading up to the migraine pain. The aura may involve visual disturbances, such as flashing lights and blind spots. There may also be stroke-like symptoms, such as numbness, confusion, trouble speaking, and vertigo (a spinning sensation).

Are Headaches a Symptom of Menopause?

Headaches and migraines are a common symptom of menopause. Research shows that hormones, especially sex hormones like estrogen, play a large role in the development of migraines. This partially explains why women experience migraines at about twice the rate of men.

Any kind of hormone fluctuation can contribute to the development of a migraine. During menopause, a drop in estrogen levels—the primary sex hormone in cisgender females—is thought to be the primary cause of menopausal migraines.

In the years leading up to menopause, your menstrual cycle changes. Periods come more frequently, causing an uptick in hormonal headaches. Hot flashes and night sweats can also trigger migraines during perimenopause and menopause.

Many women find their monthly hormonal migraines and headaches resolve after menopause. However, some women experience an increase in hormonal headaches as estrogen levels plummet even further. Many women experience more frequent tension headaches in the post-menopausal years.

What Menopause Medications Can Cause Headaches?

Medications used to treat menopause symptoms can sometimes contribute to headaches. This includes hormone replacement therapy (HRT), such as estradiol and progesterone.

While often helpful in relieving hot flashes and other uncomfortable symptoms of menopause, HRT can trigger headaches in some women. If you suspect HRT is causing your headaches, talk to your healthcare provider.

Herbal remedies used to balance hormones and relieve menopause symptoms may also cause headaches. These include:

• Black cohosh
• Evening primrose oil
• Gingko biloba
• Ginseng
• Red clover
• St. John's wort

Treatments and Management of Menopausal Headaches

A two-pronged approach of prevention and treatment is recommended for menopausal headache relief. Over-the-counter and prescription medications help relieve symptoms. Lifestyle changes, hormone therapy, and prophylactic (preventive) medications can help to reduce headache frequency.

Treating Menopausal Migraines

Some migraines respond well to over-the-counter medications. According to research, the combination of 500 milligrams (mg) acetaminophen, 500 mg aspirin, and 130 mg caffeine—the amounts found in two Excedrin tablets—is often highly effective. You may need to to take two tables every six hours until the migraine resolves (typically up to three days).

For migraine-associated nausea, Benadryl (diphenhydramine), Dramamine (dimenhydrinate), or Bonine (meclizine) can help. However, these OTC medicines can make you drowsy, so use caution.

Prescription medications used to treat migraine pain and other symptoms include:

• Triptans like Imitrex (sumatriptan), Relpax (eletriptan), and Zomig (zolmitriptan)
• Butalbital, a barbiturate, in combination with caffeine and acetaminophen (in Fioricet) or aspirin (in Fiorinal)
• Ergots such as dihydroergotamine and Cafergot (ergotamine)
• Oral steroids like prednisone and dexamethasone for migraines that last more than three days
• Anti-nausea medicine such as Reglan (metoclopramide) or Zofran (ondaseteron)

Non-drug treatments for migraine include lying down in a dark and quiet area. A cool rag on your forehead, the back of your neck, and over your eyes can help decrease pain, block out light, and reduce nausea.

Treating Menopausal Tension Headaches

Tension headaches are often treated with OTC headache medicines. These include:

• Tylenol (acetaminophen)
• Advil or Motrin (ibuprofen)
• Aleve (naproxen)
• Ecotrin, Bufferin, or Ascriptin (aspirin)
• Excedrin (acetaminophen, aspirin, caffeine)

Non-drug treatments for tension headaches include drinking more water, getting enough sleep, relieving stress levels, neck and shoulder massage, ice packs, and physical therapy to relieve muscle tension.

When to See a Healthcare Provider

For women in their 40s or 50s, menopause is one of many potential causes of headaches. If you experience frequent headaches or migraines, talk with your healthcare provider.

You should also seek medical care for any of the following symptoms:

• Headaches combined with unexplained weight loss
• Headaches that are getting worse or feel different than before
• Headaches that occur frequently and aren't relieved with OTC medication

Seek medical attention right away if your experience any of the following:

• A sudden, severe headache 
• A headache that wakes you 
• A headache that occurs with a high fever or rash
• A headache combined with dizziness or weakness 
  

Summary

Hormonal headaches like migraine and tension headaches can become more frequent during perimenopause. Menopause sometimes relieves menstrual migraines but may trigger tension headaches.

Medications and lifestyle changes can help to relieve menopausal headaches. While at-home remedies can help, it’s best to see your healthcare provider for frequent or severe headaches.  Prescription medications can treat and prevent hormonal headaches.