Do Migraines Get Worse in Perimenopause?What Studies Show

Many women with migraine notice their headaches shifting in their forties. Some get more attacks, some fewer, and some find migraine fading after periods stop. The studies help sort which is likely when.

Perimenopause: more frequent headaches

A large US survey included 3,664 women aged 35 to 65 with migraine who weren’t using hormones.¹ It compared how many had headaches on 10 or more days a month:¹

Stage	Share with frequent headaches
Before the transition	8.0%1
Perimenopause	12.2%1
After menopause	12.0%1

After adjusting for depression, weight, medicines and painkiller overuse, the higher risk held up only for perimenopause, about 1.4 times the odds.¹ It was a snapshot survey, so it shows a link, not a cause.¹

After menopause: often better, not always

Italy. Among 556 postmenopausal women, 76 had migraine or tension headaches, most of which began before menopause.²

• Migraine improved in almost two-thirds.²
• Tension headaches worsened or stayed the same in 70%.²
• Women whose ovaries were removed in surgery had a worse migraine course than women with a natural menopause.²

Norway. Among 4,825 women with a history of migraine:³

• Migraine stopped at an average age of about 50.³
• But 46% still had migraine after menopause, and about 1 in 5 after 60.³
• About 9% said their migraine started after 50.³

What to make of it

The pattern across these studies: perimenopause can bring more frequent attacks, and many women improve after a natural menopause, but a large minority don’t. Your own pattern is the best guide, which is why UK advice suggests a migraine diary to spot triggers.⁴

If migraine is part of the hormone therapy question for you, see migraine and HRT: three prescribing questions. For headaches tied to your cycle, see what a menstrual migraine is.

When to see a doctor

See a GP if attacks are getting worse, lasting longer, happening more than once a week, or hard to control.⁴ Get urgent help for:⁴

• A headache that comes on suddenly and is extremely painful
• Trouble speaking or remembering
• Vision loss or double vision
• Weakness in an arm, leg or one side of the face
• Aura lasting more than an hour

Try: “My migraines have gone from once a month to most weeks since my periods became irregular. Could this be perimenopause, and should we talk about preventive treatment?”

My Body Changed. Now What? covers which changes fade and which linger in Chapter 4, “The Change Has a Shape,” in a section called “What Passes and What Stays.” Its Visit Brief puts your stage, top three changes and health history on one page, so a shift in headaches gets the attention it needs. See the book.