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Help with migraines in the perimenopause

Updated: Aug 22, 2023

migraines in the perimenopause

Written By Kate Organ

Migraine is a genetic neurological disorder that is often characterised by severe and very painful headaches but many people experience whole body symptoms including:

  • problems with sight such as seeing flashing lights

  • being very sensitive to light (photophobia), sounds and smells

  • fatigue

  • feeling nauseous and being sick

  • dizziness

Symptoms can last between 4 hours and 3 days and have a negative impact on our ability to function. If you’re reading this its highly likely you are fully aware of the impact of migraines on your quality of life. We also know there is a strong family history of migraine, with at least a 80% genetic link. The genes for migraine adapt the brain to be more sensitive to change, particularly sensitive to changes in hormones, light, blood sugar, sleep and stress.

Unfortunately many women experience an increase in frequency and severity during the perimenopause and menopause. This is associated with fluctuating hormone levels, notably oestrogen and an increase in prostaglandins. Prostaglandins are lipid substances involved in processes such as inflammation, blood flow, the formation of blood clots during injury and illness.

Its not surprising that 3 times as many women suffer from migraines compared to men. Types of migraine and how fluctuating oestrogen levels trigger a migraine

  1. Migraine with aura Migraine with aura is often triggered by high oestrogen levels around and leading up to ovulation in a normal menstrual cycle leading to mid menstrual cycle migraine attacks.

  2. Migraine without aura Often triggered by lowering levels of oestrogen which are more prominent just before a period and for the first three days of a normal cycle.

Oestrogen levels in the perimenopause often don’t follow the normal pattern expected during a menstrual cycle as the ovarian function fluctuates and so women in the perimenopause often find an increase in frequency and duration of migraine attacks throughout the menstrual cycle.

Starting HRT It is safe for women who suffer from migraines to start transdermal oestrogen HRT, even those with aura, and HRT can help alleviate the symptoms of migraine and the perimenopause. Women who suffer migraines with aura may be at an increased risk of stroke and for this reason the combined oral contraceptive is not recommended.

Transdermal oestrogen HRT in the form of patches, gels and sprays does not increase your risk of stroke.

Tailoring HRT Stability of hormone levels is key for women suffering from migraines. We often recommend continuous HRT rather than sequential HRT for this reason and patches rather than gels or sprays where the absorption is more controlled.

Dosing Slowly, slowly to prevent migraine attacks

Supplements There is some evidence to suggest that the use of Riboflavin 400mg daily, Co-enzyme Q10 150mg daily and Magnesium 400mg increasing to 600mg daily help to prevent migraines at the correct doses.

After the menopause Women often find that their migraines improve after a natural menopause, but many women will suffer during the perimenopause for many years. Women who have a surgical menopause following a hysterectomy can often find their migraines initially worsen before settling down.

Managing your migraines

  • Maintaining steady blood sugar levels, so regular healthy meals every 3-4 hours throughout the day

  • Prioritise complex carbohydrates for slow energy release, avoiding high glycaemic index foods

  • Eating healthy fats, protein and omega 3 helps prevent migraine

  • Having good quality sleep

  • Staying hydrated

  • Mild to moderate exercise, avoiding high-intensity exercise that can provoke the head, neck and shoulders to trigger migraine attacks

Pharmacological options to manage the acute attack

  • Non-opioid pain relief such as paracetamol, ibuprofen or naproxen (avoid codeine as it is highly addictive)

  • Anti-emetic (nausea) medication to increase your gut motility such as metoclopramide, important even if you don’t feel sick.

  • Triptans such as zolmitriptan or sumatriptan

Preventative medication

  • Speak to your healthcare professional about the various options for prevention such as propranolol or amitriptyline

  • Supplements as described above


Kate Organ Consultant clinical pharmacist with specialist interests in the menopause and mental health. Founder The Menopause Specialists

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