Migraine and Perimenopause: What's the Connection?

If you're like many women, perimenopause—the years during which you transition to menopause—may be an overwhelming time filled with irregular menstrual cycles, hot flashes, vaginal dryness, mood disturbances, and difficulty sleeping. In addition to all of these symptoms, this seemingly daunting time may be made worse by an increase in migraine frequency.

This article will discuss why migraines increase with the changes of menopause and what you can do to manage your migraines as you get closer to menopause.

Can Periomenopause Cause Migraines and Headaches?

A precise explanation for why migraines increase during perimenopause is unclear, but experts suspect the following factors:

• Hormonal fluctuations: The aforementioned hormonal changes that occur during perimenopause—specifically the decline in estrogen—may be an explanation. This estrogen decline is also linked to a decline of serotonin (a neurotransmitter) in your brain, which can disrupt the function of a cranial nerve called the trigeminal nerve, which then triggers a migraine.
• Heavier periods: Perimenopause can often cause you to have heavier blood flow during your period, which can lead to iron deficiency, another possible migraine trigger.
• Increased prostaglandins: Heavy menstrual flow is also linked to an increased prostaglandin release in the body. Prostaglandins are involved in several processes, including allowing your uterine lining to shed and inflammation and blood vessel dilation, both of which can contribute to migraines.
• Disrupted sleep: You may notice that you're not sleeping as much as you used to or that your sleep is often disrupted during perimenopause. Both of these concerns are known triggers for migraines.

A study in the journal Headache used data from the American Migraine Prevalence and Prevention (AMPP) study to look at whether or not migraines increased during perimenopause for female migraine sufferers. Sure enough, the researchers found that for the 3,664 women involved in the study, the risk for developing high-frequency migraines during perimenopause—defined as having 10 or more migraines per month—was more significant than it was for women with migraines who were still in the premenopausal stage (before perimenopause and menopause).

Other studies have found that some women first start getting migraines during perimenopause. By the time women reach menopause, about 40% of them have had a migraine at some time in their life.

What Do Hormonal Headaches Feel Like?

Hormonal headaches are often caused by a drop in estrogen, which can occur just before menstruation and also is a primary driver of perimenopause. These headaches often share a few characteristics:

• Pain: Head pain can be moderate to severe, and the pain is unilateral, meaning it occurs on one side of the head,
• Sensitivity: Often, a headache is accompanied by sensitivity to light (photophobia) and/or sound (phonophobia).
• Nausea: Nausea and even vomiting may accompany a headache.
• Duration: Migraines caused by hormones can last from four to 72 hours.

Treating Your Migraine Attacks

The good news is that there are therapies to help you if you notice more migraine attacks as you near menopause.

Consider Medication

Hormone replacement therapy (HRT) at the lowest effective dose may be used during perimenopause or early menopause to relieve hot flashes and vaginal atrophy. Its effect on migraine prevention during perimenopause or menopause is nuanced, with estrogen affecting people differently depending on individual factors like medical history and age.

Eat Nutritiously

Eating a diet rich in nutrients supports overall health, and there is some evidence that migraine frequency can be positively impacted with certain diets. For example, in those with celiac disease, eliminating gluten reduced migraine, as well as other uncomfortable symptoms, once gluten was eliminated. Some studies show a diet high in omega-3 fatty acids is also beneficial to migraine sufferers.

Limit Alcohol

Alcohol is a migraine trigger for up to 75% of those who experience migraines. In particular, red wine is known to have a positive correlation with migraine. Some of the reasons for this might be related to alcohol's dehydrating effects.

Exercise Regularly

Exercise can be helpful in some perimenopause patients by not only decreasing migraine frequency but also improving mood and vasomotor (hot flashes) symptoms that are common during this period. Inactivity has been linked to migraine frequency in general, so incorporating activities like walking is advisable.

Get Adequate Sleep

Sleep disorders like insomnia and sleep apnea increase migraines in those who suffer from episodes. Getting a restful night's sleep is an important way of ensuring as many migraine-free days as possible.

Stay Hydrated

Dehydration is a well-known risk factor for headaches, including migraine. When you're dehydrated, the blood volume to the brain is decreased, which leads to poorer oxygenation. Drinking water is an excellent way to maintain hydration, but eating foods that have a high water content also helps.

Improvements After Menopause

Scientific studies are somewhat conflicting as to whether migraines improve when you're postmenopausal. Some show migraines improve after menopause and others show they worsen.

Experts suggest that the conflicting studies imply that other factors determine the likelihood of migraines after menopause. Some of these influences include:

• Depression: Having clinical depression may increase your risk of having more migraines after menopause.
• Pain medications: Using pain-alleviating medications to relieve menopause-related symptoms like muscle or joint pain could trigger medication-overuse headaches.
• Number of migraines: Whether you have episodic migraine (fewer than 15 migraines per month) or chronic migraine (15 or more migraines per month) by the time you reach menopause may make a difference. Migraines tend to improve significantly after menopause with episodic migraine, but they usually get worse if you have chronic migraine.
• Speed of hormonal changes: During perimenopause, your ovaries decrease their production of estrogen and progesterone. The more slowly they do this, the more improvement you're likely to see in your migraines, both during perimenopause and postmenopause. Conversely, rapid hormonal fluctuations seem to create the opposite effect.
• Spontaneous or induced menopause: A number of studies have shown that surgically-induced menopause (meaning that you've had your ovaries removed) is associated with migraines getting worse in a large percentage of women. This may be due to the sudden, huge shift in hormone levels, as well as the use of estrogen replacement therapy after surgery, which can actually make migraines worse in some women. However, when you go through spontaneous, natural menopause, migraines are much more likely to improve.

Summary

Perimenopause is a hallmark period that signals a decline in estrogen in your body. This can prompt a variety of changes, including migraines. It is thought that a decrease in levels of estrogen leads to increased migraine during this time. Factors that can help perimenopausal symptoms such as migraine, include medication and lifestyle changes like ensuring adequate sleep and hydration, exercise, nutrition, and limiting alcohol. Once menopause is complete, some migraine sufferers may notice a marked decrease in migraine days.