Migraines & Menopause: Does It Get Better After Menopause?

Many individuals who experience migraines during menstruation hope that the frequency and severity of their attacks will decrease after menopause. What does current research say about this, and what can you do to actively support your body?

Reading time: 12 minutes

Last updated: October 5, 2024

Migraines & Hormones

The likelihood of developing migraines increases significantly at the onset of menstruation (menarche). Before puberty, boys and girls are equally likely to experience migraines (around 4% of all children). After puberty, however, girls are about three times more likely to be affected. This suggests that hormones may play a significant role in triggering migraines.

“I’m living proof: My first migraine occurred the exact day I got my first period. For years, I had them monthly during menstruation. Later, as I entered menopause, my migraines became significantly worse, leading to 20-25 headache days per month. Naturally, I suspect hormones are the culprit. This raises the question: Could I be among those lucky individuals whose migraines improve or even disappear after menopause?

If my migraines are primarily hormone-driven, shouldn’t they subside once my hormone levels stabilize at a low baseline?”

Which Hormones Influence Migraines?

There is indeed a connection between hormones and migraines. Events like menarche, menstruation, pregnancy, menopause, and the use of hormonal contraceptives or hormone replacement therapies can affect migraine occurrence. Estrogen, in particular, is believed to trigger migraines when its levels drop. These fluctuations occur twice monthly: just before menstruation and during ovulation.

Other hormonal changes during life phases such as pregnancy and menopause also influence migraines. Research suggests that estrogen plays a role in processing pain stimuli in the brain, as it stimulates neural excitability. Both high and low estrogen levels can trigger migraines, with the fluctuations being especially relevant for menstrual or menstrual-related migraines.

Additionally, other hormones like insulin can become imbalanced during menopause, potentially impacting migraines. Insulin resistance, a condition where the body becomes less sensitive to insulin, is more common during perimenopause and can lead to migraines, weight gain, and cravings. Since insulin impacts sex hormones like estrogen, progesterone, and testosterone, keeping insulin levels stable may help.

Migraine Relief through Personalized Nutrition

Medication Free
Side Effect Free
Based on Science

What Happens in the Body During Menopause?

Menopause, also known as the climacteric phase, marks the time in a person’s life when their egg supply is depleted, and the reproductive system’s functionality diminishes, making pregnancy no longer possible. This transition is accompanied by a decline in the hormones progesterone and estrogen, leading to symptoms like hot flashes, night sweats, and mood swings.

Duration of Menopause

Menopause begins with the premenopause phase and extends through to postmenopause. It can start as early as age 40, with symptoms lasting an average of 7.3 years. For those who experience early symptoms during premenopause, they may last up to 11.8 years. Conversely, symptoms that appear later, during postmenopause, last an average of 3.4 years.

The Four Phases of Menopause

Premenopause

Premenopause marks the beginning of menopause. In scientific literature, the distinction between premenopause and the following perimenopause is not entirely clear. However, premenopause occurs before perimenopause and appears to be associated with the first hormonal changes.

Perimenopause

This phase describes the 4 to 10 years leading up to the last menstrual period. It is characterized by a decline in progesterone levels and is often accompanied by estrogen dominance.

The sex hormone progesterone plays a crucial role during the reproductive years by ensuring that a fertilized egg can implant in the uterine lining. As the reproductive phase comes to an end, the body gradually stops producing progesterone. The drop in progesterone levels, combined with high estrogen levels, can lead to symptoms such as breast tenderness or water retention.

Later, estrogen levels also begin to decline. This drop manifests in irregular cycle lengths and sporadic absence of menstruation. Other accompanying symptoms may include hot flashes, night sweats, sleep disturbances, heart palpitations, dry skin and mucous membranes, osteoporosis (bone loss), and depressive moods¹⁰.

Menopause

Menopause is defined as the absence of menstruation for at least one year. On average, it occurs at the age of 51¹⁰.

Postmenopause

Postmenopause refers to the phase after menopause, during which female sex hormone levels stabilize at their lowest point. Hormonal fluctuations gradually subside¹⁰.

Migraines & Menopause: Do Migraines Worsen During Menopause?

A meta-analysis by Ripa (2015) found that during menopause, particularly perimenopause, migraine frequency and severity often increase due to dramatic hormonal fluctuations. However, for about 60% of women, migraines decrease or disappear entirely after menopause, likely due to the consistently low estrogen levels.

Treatment: What Helps with Migraines During Menopause?

Nutrition

Estrogen influences insulin sensitivity, and a high insulin level can, in turn, affect sex hormones. To counteract the risk of insulin resistance, a low-glycemic diet can stabilize blood sugar and insulin levels.

Tools like the Ebby app can help identify foods that keep your blood sugar stable, preventing migraines. For example, pairing carbohydrates like potatoes or oatmeal with protein, fats, or coffee can reduce blood sugar spikes, preventing migraines without side effects.

Phytoestrogens & Herbal Remedies

Foods rich in phytoestrogens, like soy, chickpeas, flaxseeds, and broccoli, mimic estrogen and can support hormonal balance. Herbal remedies like St. John’s Wort, chasteberry, and black cohosh may also help regulate estrogen levels.

Hormone Replacement Therapy (HRT)

HRT involves the administration of estrogen, progesterone, or both to alleviate menopause symptoms. While HRT can stabilize estrogen levels, its effects on migraines are mixed and require further study. Important:Those with migraine with aura should avoid estrogen-based HRT due to an increased stroke risk.

Conclusion

Hormonal fluctuations—whether from estrogen, progesterone, or insulin—can trigger migraines. While many women experience fewer migraines after menopause, perimenopause often brings worsening symptoms. A low-glycemic diet and hormone therapy are potential strategies, but individual approaches vary.

For those with aura migraines, stabilizing blood sugar remains a safe and effective option. Consider tools like the Ebby app to help tailor a migraine prevention plan to your unique needs.

Sources

Deutsche Migräne- und Kopfschmerzgesellschaft. Migräne und Hormone. (2005).
Martin, V. T. et al. Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine: Results of the American Migraine Prevalence and Prevention Study. Headache 56, 292–305 (2016).
Ripa, P. et al. Migraine in menopausal women: a systematic review. Int J Womens Health 7, 773–782 (2015).
Savukoski, S. M. et al. Onset of the climacteric phase by the mid-forties associated with impaired insulin sensitivity: a birth cohort study. Menopause 28, 70–79 (2020).
Gruber, H.-J. et al. Hyperinsulinaemia in migraineurs is associated with nitric oxide stress. Cephalalgia 30, 593–598 (2010).
Siva, Z. O. et al. Determinants of glucose metabolism and the role of NPY in the progression of insulin resistance in chronic migraine. Cephalalgia 38, 1773–1781 (2018).
Yilmaz, N. et al. Impaired oxidative balance and association of blood glucose, insulin and HOMA-IR index in migraine. Biochem Med (Zagreb) 21, 145–151 (2011).
Petersen, M. C. & Shulman, G. I. Mechanisms of Insulin Action and Insulin Resistance. Physiological Reviews 98, 2133–2223 (2018).
Avis, N. E. et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med 175, 531–539 (2015).
Seifert-Klauss, V. Neuzeit der Hormon- bzw. Hormonersatztherapie. Frauenarzt 56/6 https://www.frauenarzt.de/index.php/heftarchiv/56-jahrgang-2015/frauenarzt-6-15.
Wang, S.-J., Fuh, J.-L., Lu, S.-R., Juang, K.-D. & Wang, P.-H. Migraine prevalence during menopausal transition. Headache 43, 470–478 (2003).
Bongiovanni, D. et al. Effectiveness of ketogenic diet in treatment of patients with refractory chronic migraine. Neurol Sci 42, 3865–3870 (2021).
Evcili, G., Utku, U., Öğün, M. N. & Özdemir, G. Early and long period follow-up results of low glycemic index diet for migraine prophylaxis. Agri 30, 8–11 (2018).
Razeghi Jahromi, S. et al. Association of diet and headache. J Headache Pain 20, 106 (2019).
Lelleck, V. V. et al. A Digital Therapeutic Allowing a Personalized Low-Glycemic Nutrition for the Prophylaxis of Migraine: Real World Data from Two Prospective Studies. Nutrients 14, 2927 (2022).
Domínguez-López, I., Yago-Aragón, M., Salas-Huetos, A., Tresserra-Rimbau, A. & Hurtado-Barroso, S. Effects of Dietary Phytoestrogens on Hormones throughout a Human Lifespan: A Review. Nutrients 12, 2456 (2020).
Laakmann, E., Grajecki, D., Doege, K., zu Eulenburg, C. & Buhling, K. J. Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review. Gynecol Endocrinol 28, 703–709 (2012).
van Die, M. D., Burger, H. G., Teede, H. J. & Bone, K. M. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med 79, 562–575 (2013).
MacGregor, E. A. Migraine, menopause and hormone replacement therapy. Post Reprod Health 24, 11–18 (2018).
Schürks, M. et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 339, b3914 (2009).

About the Author

Miriam Jansen

Miriam had to give up her job due to chronic migraines - and became a migraine expert during this time. The migraine helped her to make a radical change in her life: She now lives as a digital nomad in her bus and works as a copywriter & as a shepherdess on an alp.