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Headaches and migraines occur during menopause for many women. With the link between headaches and hormones well established, it should come as no surprise that the hormonal fluctuations which begin during perimenopause amplify both their frequency and duration.

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    The science

    Headaches and migraines are far more pronounced during perimenopause, or the transition period between the onset of the first symptoms and the onset of full-fledged menopause, which is marked by 12 consecutive months without a period.

    One reason? Hormone fluctuations — specifically drops in estrogen.

    Before perimenopause, our hormones enjoy a predictable ebb and flow throughout our cycles. We might occasionally experience menstrual migraines before our period as estrogen levels drop, but for the most part, all is well. Then comes perimenopause, which is marked by one long hormonal fluctuation as levels of the two key female hormones (estrogen and progesterone) vary quite a bit. Post-menopause, it’s low and steady as estrogen levels stabilize and headaches and/or migraines tend to dissipate.


    Up to 29% of women experience migraines during the menopause transition. For those experiencing migraines before perimenopause, migraines often get worse as the transition evolves. However, even women without a history of these headaches may start to get them. About 8-13% of women report new onset migraines during perimenopause. And unfortunately, for some, these headaches persist into the postmenopausal period.

    Non-migraine headaches

    Non-migraine headaches can have a slightly different pattern. One study of perimenopausal women found that 48% had new-onset headaches (i.e. headaches that didn’t occur prior to perimenopause), 34% had an aggravation of prior headaches, and 18% had no change in their headaches.

    Not sure if what you’re experiencing is a headache or a bonafide migraine? Here’s a quick headache 101:

    • Tension headaches: cause moderate pain, come and go over time, most common among adults and teens
    • Migraine headaches: far more debilitating than headaches, characterized by throbbing pain on one side of the head as well as light and sound sensitivity
    • Cluster headaches: most severe, marked by intense burning or piercing pain behind or around one eye, can be throbbing or constant
    • Sinus headaches: deep, constant pain in your cheekbones, forehead, or bridge of your nose when cavities in your head (i.e. sinuses) get inflamed

    It should be noted that most headaches are NOT hormonally caused, but rather triggered by factors such as stress, alcohol, allergies, etc. However, if you experience a sudden onset of headaches or migraines without any past history, it may be worth consulting a neurologist for an evaluation.

    What you can do

    We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

    A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.

    Nutrition & Diet

    While there’s isn’t hard evidence around a specific diet to stop headaches and migraines, anecdotal evidence points to potential “trigger” foods to avoid, including alcohol (specifically red wine and beer), caffeine, aged cheeses, chocolate, cured meats, food preservatives (nitrates, nitrites, MSG, artificial sweeteners), smoked fish, and yeast extract.

    Those suffering from headaches are also advised not to skip meals since prolonged hunger and low blood sugar levels can be a trigger. Instead, make time for smaller, more frequent meals.

    Holistic Practices

    For an integrative approach to headache management, it’s important to prioritize quality sleep, which can be challenging during perimenopause. Our founding physician, Dr. Anna Barbieri, MD has some favorite daily habits to foster better sleep. Here are just a few to get started — to learn more, check out Elektra’s guide to managing sleep during menopause.

    Schedule wisely

    Carve out time for a wind-down routine. Take a warm bath, sip a cup of herbal tea, and take a few minutes to journal. Doing so will lower sympathetic activation (your body’s fight or flight system).

    Stick to a consistent bedtime

    If the schedule of when we are asleep and awake varies considerably, it can throw off the physiological part of our bodies, which thrives off a 24-hour circadian rhythm. If you can, try and make this work on the weekends, too.

    Keep it cool

    Right around bedtime, your body temperature drops 1-2 degrees, which signals to your internal clock that it’s time to hit the hay. In doctor-speak, this is what’s called “thermoregulation.” We recommend keeping your bedroom at a cool 60 – 67°F and, if that’s not enough, trying cooling sheets made with bamboo or a cooling mattress pad or blanket for your bed.


    Regular exercise is a go-to preventive strategy to help reduce the frequency and severity of migraine and tension-type headaches — in fact, research suggests it may be *just* as effective as using prescription medication. One study in particular found that those who performed aerobic exercise for 40 minutes at least three times per week had a similar reduction in migraine frequency as those who took topiramate (a common medication for migraines).

    Supplements & Over-the-Counter Solutions

    Supplements and over-the-counter solutions can be effective in managing headaches and migraines…if you choose wisely. We recommend consulting with your healthcare provider first to ensure you’re using something with optimal efficacy and safety (i.e. backed by clinical research) or consulting with Elektra’s providers. Here’s a quick primer from our team on how to go about selecting high-quality supplements.


    This mineral, which is found on earth and in the human body, plays a role in over 300 biochemical reactions. It’s found naturally in foods like leafy greens, salmon, nuts, seeds, and legumes, but many Americans don’t get enough through dietary sources. One study found that those who took magnesium for 12 weeks had 42% fewer migraine attacks, compared with 16% fewer attaches for the placebo group.

    Note: The most common side effect is upset stomach, which can be prevented by taking magnesium glycinate or magnesium L-threonate.


    Riboflavin, aka Vitamin B2, is one of eight B vitamins that helps metabolize fats and proteins in order to convert food into energy. In a small study conducted by the European Journal of Neurology, participants who took 400 mg of riboflavin daily for six months reported half the number of monthly headaches, from four to two.



    Hormone replacement therapy (HRT) can be effective in maintaining a stable estrogen environment and, as a result, preventing hormonal fluctuations that can trigger headaches and migraines. So for some women, this may be an option to manage hormonal migraines. But, as we’ve said many times before (and will continue saying), HRT is a decision that should only be made by you and your doctors — in this case, a gynecologist AND a neurologist. It’s imperative to take into account individual needs and specific health history.

    Here’s what you need to know about the two main types of HRT:

    Oral HRT

    As the name suggests, oral products are taken by mouth in tablet or capsule form. Women experiencing migraines with aura (which occurs when migraines are associated with flashes of light, blind spots, and other vision changes) are at an increased risk of stroke with this form of hormone therapy. Just like with oral estrogen, estrogen-containing birth control pills are also contraindicated for women with migraine with aura. The exception would be strictly menstrual migraines which can be treated with oral hormones.

    Transdermal HRT

    Transdermal HRT is available as a patch or gel applied directly to the skin. If HRT is considered as part of your migraine treatment plan, then transdermal estrogen is typically the better option as it does not impact cardiovascular and stroke risk.

    Important note: When it comes to migraines, hormone replacement therapy does not work for everyone. Certain women experience no changes at all, while others may experience worsening headaches as a side effect of HRT. If this occurs, providers usually lower the estrogen dose, stop it altogether, or swap it out for a different form of estrogen. Transdermal estrogen is least likely to trigger headaches as it provides a steady supply of the hormone.

    READ MORE: The Elektra Guide To Hormone Replacement Therapy In Menopause


    Non-hormonal treatments have been found effective in the prevention and treatment of migraines. The most common include:

    • Botox: FDA-approved for those experiencing chronic migraines 15+ days per month
    • Fluoxetine & Venlafaxine: two antidepressants commonly used to help with vasomotor symptoms (i.e. hot flashes/hot flushes & night sweats) that also combat migraines by targeting specific pathways in the brain
    • Triptan: a group of medications used to ease the symptoms of cluster headaches or migraines

    We’re always keeping an eye out on emerging research and the latest clinical studies. Subscribe to our weekly Elektra Digest for the latest, science-based info direct to your inbox. Something work well for you that’s not listed here? We want to hear it! Shoot us a note at [email protected]. (We’re human, promise.)

    Disclaimer: This information is for general educational purposes, and should not be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem.

    As with anything you put into your body, taking dietary supplements can also involve health risks. You should consult a medical professional before taking supplements and inform your doctor about any supplements, as well as any medications you already take, since there may be interactions.


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