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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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Muaz
    2 years ago

    Very informative. Thanks for sharing.

  • aks868
    3 years ago

    Hi. This is the first time I have posted. I am 48 and have been suffering with Chronic Migraines for 8 years. I am definitely in perimenopause and have been telling all my doctors over the years that the fluctuating hormones are the root of a lot of the evil. Weather and food triggers also contribute. I am taking progesterone and using the vivelle dot patch, but no one wants to try a Lupron shot to shut down my hormones and see if that helps. Has anyone tried that and what are your thoughts? Also, has anyone tried the Cgrp therapy or any of the surgeries, such as neural implants? I am getting a bit tired of all the meds and their endless side effects and lack of efficacy. By the way, I have also incorporated alternative therapies, but they only go so far in helping. Thank you for your time!

  • Crystal
    3 years ago

    Dr Hutchinson,
    All if a sudden I went from episodic to chronic within the past year. I am 38. I have always done poorly with the pill and had menstrual migraines. So my gyno and I decided to remove the pill because hormones seemed to increase my migraines. Tried the paraguard and my bleeding was out of control. I got a tubal ligation. But in the mean time I started having hot flashes. So when I went to my follow up from the tubal they tested my levels and I have started menopause.
    The hot flashes have all but stopped but I haven’t had my period in 6 months. And my migraines are out of control. Please tell me this is going to stop when the menopause does. And that menopause is almost done!

  • Luna
    3 years ago

    My migraines got worse after menopause. Now 15 years later they have changed to daily but mild.

  • Ellen Schnakenberg
    6 years ago

    Dr Hutchinson, what do you recommend for young post-menopausal women who have seen reduction in their Migraines with the elimination of HRT, yet for other medical purposes need some kind of replacement in place? Are there other options for them similar to estrogen/HRT?

  • Laura
    6 years ago

    I will share my experience. When the neurologist asked the gynecologist to take me off of HRT my hot flashes surfaced and were practically disabling. I could not sleep. So my gynecologist put me on Venlafaxine to help control the hot flashes . It helps, though not nearly as much as the HRT helped. He also prescribed an estrogen vaginal cream for vaginal symptoms.

  • Dr Hutchinson author
    6 years ago

    For Laura,
    Your frequency of migraine attacks points to the need for a more effective preventive regimen that can include prescription preventive medication, non-pharmacologic treatment such as Petadolex, B-2, magnesium, Coenzyme Q-10, exercise, biofeedback, etc. Hormonal therapy could help. Do not give up on finding an effective preventive regimen and do not feel your current pattern is going to continue into old age. I recommend finding and working with a headache specialist in your community.

  • Laura
    6 years ago

    Thank you for the reply. I am currently seeing a fourth neurologist that is also a headache specialist. I drive 3.5 hours to see her. I’ve tried
    NSAIDs
    Opioids
    triptans
    ergotamines
    anti-depressants
    anti-convulsants
    beta blockers
    calcium channel blockers.
    torodaol injections
    DHE 45 injections
    B-2
    magnesium
    Q-10
    exercise
    biofeedback
    butterbur
    feverfew
    massage
    acupuncture

    None of it has helped. I was on HRT, but was taken off of HRT to see if that would help. It did not. The latest drug I’ve tried is Cymbalta, but its not helping either.

    The most helpful thing I’ve tried is a Medrol Dose pack, but they say I can only have those 3 times a year.

    I had a peripheral nerve stimulator trial, but the doc said I am not a candidate for the permanent implant.

    The next recommendation is to talk to a specialist about whether or not I am a candidate for gamma knife therapy. I am almost 48 and, after 8 years of this I am starting to feel like this will continue indefinitely. Despite all the interventions I’ve tried, the problem has just gotten worse.

    Do women ever just “grow out of it” after this many years post-menopause?

  • Laura
    6 years ago

    Dr. Hutchinson,
    My migraines began with peri-menopause in 2004. After trying a multitude of different treatments and doctors I have daily pain and migraine attacks 2 to 5 days a week. Is this now an established pattern that will be impossible to stop and likely to continue into old age or will it ever taper off?

  • suze a
    6 years ago

    I’m a 59-year old woman who is now 3 1/2 weeks into a what has now been diagnosed as Status Migrainosus, beginning with a Thunderclap Headache, sudden onset vomiting… an indescribable nightmare. I’m on my third round of Prednisone. I was released from the hospital after three days of Prednisone and Dilaudid seemed to be calming things down, but when the taper reached 20mg on day 6, the excruciating pain came roaring back. Round 2 of Pred. started at a little higher dose given all at once, same time of the day, while starting Topamax 25mg at night, and will be up to total dosage of 100mg beginning tonight (over span of 2.5 weeks). Again the acute pain responded to Pred, but when the taper reached day 3 of 20 mg, I relapsed into excruciating head pain once again. Round 3 of Pred. started at 60mg for 2 days, then 40mg for 3, and tomorrow starts 20mg for 3 days, then 10mg for 3, and then off. And yes, I’m nervous, very nervous. Yesterday and today are the best i have felt for the past month, thus my scouring of the internet and my post here.

    I’m thrilled to find this website, and i apologize for taking up so much space right off the bat, but i am so desperate to find some help. I’m not new to migraines, but NOTHING like this. I’ve maybe had 3-4 per year, usually lasting 4-5 hours, gone after a good night’s sleep. I’ve been racking my brain as I’ve been lying in bed for the past 26 days as to WHAT could have brought something like this on!!!

    So here’s my big question… I’m perimenopausal and my primary had given me some ESTRACE cream to try about 6 weeks ago for vaginal dryness! COULD THIS HAVE SOMETHING TO DO WITH THIS???

    Any other thoughts? Help! Please?

  • Dr Hutchinson author
    6 years ago

    And yes, I have seen migraine exacerbation from Estrace cream; if a patient in my patient thinks a new medication is causing or aggravating her migraines, the only choice we have is usually to stop the medication and see if the headaches improve. Some women are sensitive to very small changes in estrogen.

  • Dr Hutchinson author
    6 years ago

    Suze,
    I am concerned that you describe the onset as “thunderclap” and the worse pattern you have ever had. I trust you had an MRI and MRA of your brain when you were in the hospital to make sure there was not an aneurysm or a bleed or a tumor or anything serious causing this recent severe headache pattern.

  • Ann
    6 years ago

    I was prescribed Estrace cream for chronic UTIs after menopause by my urologist and got migraines from its use. I had to stop using it. They were no where near the severity of yours though.

    Also I would like to comment on the article. I suffered from hormonal monthly migraines for years without aura. I am now post menopausal for 10 years and my migraines stopped 15 years ago but returned 5 years ago when I was diagnosed with Hashimoto’s thyroiditis. Migraines are a comorbidity for Hashimoto’s. These migraines are 10 times worse than my hormonal ones because I am dizzy, nauseous, my right side of my body becomes numb and I have occular problems too besides the throbbing pain. The funny thing is I was told I probably had Hashimoto’s for years before being diagnosed as there are other symptoms from the disease that I suffered with for years prior to the diagnosis.

    Another point I’d like to make is: The prescription drugs only work for 9 months to a year.

  • Nancy Harris Bonk moderator
    6 years ago

    Hi suze,

    I’m sorry you are having a rough time right now. From research I’ve done and the prescribing information, Estrace cream can create an exexacerbation in migraines. You can find the prescribing information in this link; http://www.wcrx.com/pdfs/pi/pi_ppi_estrace_cream.pdf.
    Please speak with your doctor about this, and it may be time to pick another option.
    Let us know how you make out, OK?

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