Expert Answer: Migraine and Menopause
Fortunately, migraines will go away or improve in 2/3 of women entering menopause naturally. Natural (also referred to as spontaneous) menopause refers to the natural progression of the ovaries decreasing the production of estrogen and progesterone as women age. Eventually, the production stops and there are no periods and no more fluctuating estrogen and progesterone levels from the ovaries. The average age of menopause is 52.
This improvement in migraines could be dramatic for women with a strong association of their migraines to hormone changes, including menstrual migraine. However, most women migraine sufferers have non-hormonal triggers that could extend into menopause. Those triggers such as weather change, stress, lack of sleep, and dietary triggers could still contribute to migraines well into menopause.
Another factor to consider is whether hormone therapy is used in menopause. Oral estrogen may have unpredictable absorption and inconsistent hormonal blood levels. In the case of Premarin, a commonly prescribed oral estrogen, I have often seen an increase in migraines. In contrast, I have seen a transdermal estradiol in the form of the Vivelle dot patch result in improved migraines as it helps to create a nice even level of estradiol in the bloodstream.
A colleague of mine in the headache world, Dr. Vince Martin, has done studies showing that for some women, it is not just changes in estrogen that can trigger migraine but for some women, the absolute level of estrogen is important. Specifically, for some women, the much lower levels of estradiol in the menopause could be a trigger for migraine aggravation. For these women, estradiol (estrogen) therapy can be helpful for prevention of migraine.
Lastly, it is important to note that improvement in migraines may not occur until 1-2 years into menopause. The highly fluctuating hormone levels of perimenopause often wreck havoc on migraine control and then the early years of menopause are often complicated by insomnia, irritability, hot flashes, and night sweats. So, there is improvement eventually for most women after the first 1-2 years of menopause but patience is required as that improvement is not immediate.
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