Headaches and hormones, or is it a migraine…yet another seemingly common symptom of the menopause.

Firstly, have you got a headache or a migraine. Is it related to those fluctuating hormones, the tipple you had the night before, any food you might have eaten, or just the stresses of life?

Well…research has shown probably no connection to foods, most of us have experienced a night when we have had too many tipples, so can relate to the pitfalls there, but headaches and hormones…really? Unfortunately yes, however, as always with the menopause not everyone will experience this symptom.

Women experience more headaches than men – stats say we are three times more likely to be affected by them…oh joy!

There is definitely a connection between hormone fluctuations and the prevalence of headaches/migraines being experienced making it a condition of our reproductive years…more joy! Think back to your teenage years or have a look at those teenage daughters on their cyclical rotation slamming doors and stomping around complaining of headaches…sound familiar?

Headaches can last between 4 and 72 hours, but are you experiencing a headache or a migraine…

There are three key questions to ask yourself to confirm if the headache you are experiencing can be classed as a migraine and if yes should then be treated as such…

  • Does light bother you more than usual, doesn’t have to even be bright lights?
  • Does your headache limit your ability to concentrate or do what you need to do for at least one day?
  • Do you feel sick or nauseated?

If you can answer yes to two of those questions then 93% of the time you can safely say you are experiencing a migraine. Yes to three of those questions and that goes up to 98%.

Can I just touch a bit on aura…ok so you either have migraines with or without aura. Headaches due to reduced levels of oestrogen tend to be without aura, those with spiked levels of oestrogen however are usually accompanied with aura. There will of course always be exceptions to this rule!

The without clan roughly make up 70-80% of the population, so that makes 20 – 30% with aura and there is then the 1% who have the migraine aura without headache. Stay with me…

What is aura do I hear some of you say…simply put they are visual, zig zag lines (visual disturbances) experienced prior to a headache. They typically last between 20 and 30 mins but usually resolve before the headache gets underway. If you are experiencing aura when you close your eyes you will still see those zig zag lines. You may also experience a sensory aura in your arm which can feel like you have a ‘dead’ arm prior to a headache, these rarely occur without the visual aura.

Other common symptoms which might sound familiar to you if you get a lot of headaches…

Prior to aura starting you may have a stiff neck, feel tired, get blurred vision, be irritable (back to those teenagers!), and have food cravings.

Once the aura has gone and the headache sets in you can feel nauseous, in extreme cases you can experience vomiting, continue to feel tired, have heightened senses of smell and reaction to bright lights, experience poor concentration and have difficulty focusing.

Once the headache starts to subside you can still feel tired, may feel as if you are experiencing a hangover and have limited food tolerance…picky teenagers come to mind again, bless them!

Gosh I’m just feeling exhausted writing about this! As always important words to note are can and some – only a percentage of women experience hormone related headaches and migraines.

If prior to your perimenopause getting under way you have a tendency to have headaches then with spiking and fluctuating hormones more often than not these will continue and can accompany the likes of hot flushes and night sweats.

Dealing with migraines whilst going through the menopause can have additional hassles if you decide to take HRT. Obviously taking HRT means that you are replacing those declining levels of oestrogen and progesterone which for some women means they will experience headaches or migraines for the first time. A way around this is to look at the delivery route of your HRT. Oral oestrogen can increase the amount of headaches experienced and for some that means migraines. A good way to combat this without having to stop your HRT is to try transdermal HRT, so either through a patch or gel, altogether a better delivery system and can really help not only where headaches/migraines are concerned but is also known to provide a better delivery system from a cardiovascular perspective. The progesterone part of HRT can contribute too so again have a look at the delivery route, preferred routes would be an intrauterine system as in the mirena coil or to take the progesterone continuously. Each woman will obviously react differently so always consult an experienced HCP.

Advice as always, if anyone experiences migraine with aura they should be checked out by their GP to exclude any other possible medical causes.


To summarise:-

  • If on oral HRT change to a transdermal route.
  • If commencing HRT then start with the transdermal route and try the lowest dose of oestrogen
  • If aura continues even on transdermal then consider non-hormonal options.
  • As with any symptom the healthier you are the better your body will cope with any symptom that rears its ugly head, so please don’t forget…look at your diet, look at your exercise levels and make sure you are getting some R&R time.
  • It’s a no brainer to look at your caffeine and alcohol levels.
  • Alternative therapies and remedies can be explored and tried but always seek experienced advice rather than self medicating.

Useful reading from previous posts :  https://tinyurl.com/yybjruq7

Essential reading Womens Health Concern fact sheets : https://tinyurl.com/y68wpb43