Hormone Fluctuations Can Be a Headache in Menopause

By Cindy Moy Carr, founder of mySysters

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The First Migraine

The headache started while I was running errands on a Saturday morning.

I was in my early 40s, and this headache felt different than any I’d ever experienced.

Within a few minutes the pain worsened, and I headed for home.

By the time I reached my house—less than 15 minutes—the pain and nausea were so bad I was seeing spots and could barely walk to the bedroom.

My skull felt as though it was cracking open at the seams.

I’d never had a migraine but I’d cared for a friend who had, so I was fairly certain I was experiencing my first one.

Convinced it was a fluke, I went on with life once it passed.

The Second Migraine

A few weeks later, a second migraine hit; this one even worse.

I knew from caring for my friend that migraines normally begin when people are teenagers.

Why would I get migraines in my 40s?

It would be a decade and dozens of fruitless doctor appointments before the word ‘perimenopause’ would enter my vocabulary.

Nearly 20 years later and we’re still woefully uninformed about the link between migraines, headaches and hormones.


Estrogen is involved in the development and regulation of the female reproductive system.

Headaches can be triggered whenever estrogen levels fluctuate, including drops in estrogen levels around the menstrual cycle.

Women may also experience more frequent headaches at the onset of menopause and after a hysterectomy.

Pre-adolescent girls and boys suffer from headaches with equal frequency.

However, it occurs more often in girls during puberty or the beginning of menstruation and resolves only after menopause.

To find out if your menstrual cycle is affecting your headaches, try keeping a calendar of when your symptoms start.

If you see a pattern, your doctor may be able to offer some preventive measures and treatments, such as stopping your menstrual cycle, possibly with the help of medication, if the pain is extreme.

Migraine headaches can be particularly troublesome during the transition from perimenopause to menopause.


Migraine is a type of headache characterized by

  • pain,
  • nausea, and
  • sensitivity to light and sound.

They usually affect one side of the head and can last hours or days.

For many women, perimenopausal hormonal headaches may be due to the hormonal fluctuations that occur during this time.

Perimenopausal symptoms such as

  • sleep disturbances,
  • stress, and
  • hot flashes can also trigger migraines.

How To Tell If It’s A Migraine Or A Severe Headache

But how do you tell if it’s a normal headache or something more severe such as a migraine?

A few things to note:

  • Location: Migraines usually cause headaches on only one side, whereas tension headaches usually affect both sides.

  • Intensity: Migraines are often much more severe than tension headaches. If your headache is severe enough to interfere with your daily life, you may have a migraine.

  • Duration: Migraines usually last for hours (or days), while tension headaches are shorter.

  • Symptoms: In addition to pain, migraines often cause other symptoms such as nausea, dizziness, and sensitivity to light and noise. Tension headaches, on the other hand, are usually not accompanied by other symptoms.

Of course, the only way to know for sure if you have menopausal headaches is to see a doctor.

However, if you’re unsure whether to see a doctor, use these guidelines to help you decide.

Migraine Headache Symptoms

  • typically last four to 72 hours (this includes pre-headache and post-headache symptoms)
  • spots or zigzag lines in vision (only among 15–25 percent of headache sufferers)
  • pain on one side of the head (15 percent of patients can have pain on both sides)
  • pain worsened by physical activity
  • sensitivity to light, sound or smell
  • nausea and/or vomiting (people with tension headaches typically do not have nausea)

Perimenopausal Headache Treatment

Although there is no cure for migraines, there are treatments that can help reduce the frequency and intensity of migraine headaches.

For some women, hormone replacement therapy (HRT)/menopausal hormone therapy (MHT) helps relieve migraines, while others benefit from acupuncture and chiropractic care.

Over-the-counter pain relievers such as ibuprofen and acetaminophen can help relieve pain, while prescription drugs such as triptans can provide more targeted relief.


A healthy lifestyle with an emphasis on stress reduction and sleep hygiene may be recommended for migraine headaches.

It often helps prevent outbreaks in the first place.

Nonetheless, every woman’s case is unique, so talk to your doctor to find the best treatment plan for you.

Although it is estimated that menopausal migraines will be experienced at some point in life, there are some things women can do to prevent migraines during this time.

First, it’s important to maintain a regular sleep schedule and get enough rest.

Second, staying hydrated is important because dehydration can cause migraines.

Drink plenty of water throughout the day and avoid caffeine and alcohol.

Both can cause dehydration.

Finally, try to control stress levels, as stress is a common trigger for migraines.

Exercise, meditation, and deep breathing can help reduce stress.


HRT is not a cure for migraines, but migraine sufferers can use certain types of HRT to control other menopausal symptoms.

People with headaches respond differently to HRT.

If you are taking HRT to control other menopausal symptoms and find that your headaches get worse, ask your doctor about switching to a transdermal formulation (HRT patch or gel) or reducing your estrogen dose.

Transdermal formulations (HRT patches or gels) are usually the safest for people with migraines.

HRT works for most people, but it’s not for everyone.

Talk to your doctor about whether it’s right for you.

Always check with your doctor or pharmacist before starting or discontinuing treatment.


While medications may be effective in treating migraines and headaches, ice has long been used as a headache and migraine treatment and has no side effects.

In fact, using cold therapy for headaches is at least 150 years old.

When your head hurts, applying ice makes sense because it is frequently the “go-to” treatment for pain and inflammation.

Blood vessels narrow as a result of the cold, which can also lessen pain’s neurotransmission to the brain.

Studies show that applying a frozen neck wrap at the beginning of a migraine considerably reduced pain in people with migraines.

Your ability to get relief faster depends on where you place the ice pack.

Applying ice as a neck wrap can help ease the pain and suffering associated with headaches and migraines.

The Cool Wrap Chill from Opal Cool from Opal Cool is a safe, drug-free alternative that delivers natural cool therapy for migraines, headaches and hot flashes.

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The carotid artery in the neck was thought to be chilled by an ice pack such as Cool Wrap Chill from Opal Cool, according to researchers.

This lessened brain inflammation, which lessened the agony that migraine sufferers experience.

Applying the ice pack for 15 to 20 minutes at a time works best when using cold therapy for headaches or migraines.

Another great option is a cooling eye mask.

This cooling eye mask from Opal Cool from Opal Cool is safe to wear directly on the skin, latex free, and HSA and FSA reimbursable.

For a limited time get 20% off your order by using promo code mysysters20 at checkout.

Cindy Moy Carr is the founder of mySysters , the first mobile platform for perimenopause and menopause. She’s an attorney, journalist and author of several books, including the ABA’s Guide to Healthcare Law. She founded mySysters based on her own experience with perimenopause.

The information and other content provided in this blog, website or in any linked materials are not intended and should not be considered, or used as a substitute for, medical advice, diagnosis or treatment.