Hormonal changes, including those that happen during perimenopause, can trigger migraine episodes.

Perimenopause, the period of time when the body is transitioning to menopause, often means big changes in hormone levels. People with migraine who are in perimenopause may experience changes in the number and severity of their migraine episodes.

Migraine vs. headache

Migraine is a neurological disorder that can cause many debilitating symptoms, including headaches. However, migraine episodes typically occur with additional symptoms, such as:

  • sensitivity to light, sound, or touch
  • nausea
  • aura, or visual distortions
  • moderate to severe throbbing head pain that affects one or both sides of the head
  • muscle pain
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Perimenopause is the last stage of the reproductive period and marks the transition to menopause. It lasts for about 4 years on average and usually starts in your 40s. Pregnancy is still possible during perimenopause, but it’s less likely.

Some classify perimenopause into early and late perimenopause. Early perimenopause typically involves mostly regular menstrual cycles with few interruptions. During the later transitional stage, you may experience a more prolonged absence of menstruation, for up to 60 days, until you reach menopause. The late transition may last for 1–3 years.

The average age of menopause in the United States is 52 years. You’ve reached menopause if it’s been a full year since your last menstrual cycle.

According to the North American Menopause Society, people in perimenopause may start to notice:

  • irregular periods
  • hot flashes
  • vaginal dryness
  • mood swings
  • interruptions to sleep


Perimenopause is a time of hormone fluctuation. Your levels of estrogen and progesterone can fluctuate a lot during this time.

These hormonal changes can mean an increase in the frequency and severity of migraine attacks. This is particularly true if you’ve had a history of menstrual migraine, which is triggered by the change in hormone levels before each menstrual cycle.


Once perimenopause is over and menopause begins, migraine attacks tend to decrease. In one review of studies, researchers found that many people saw improvement in migraine symptoms after natural menopause, including complete remission.

Research indicates that natural menopause is linked to migraine improvement, while surgical menopause or medication-induced menopause can lead to a worsening of migraine symptoms.

Surgical menopause occurs when a procedure, such as a hysterectomy, causes the body to go into menopause. Researchers believe this type of menopause is more likely to trigger migraine symptoms because it creates a sudden drop in hormone levels.

For some people, migraine may improve once their hormones stabilize after a hysterectomy, but it isn’t known how long that might take. It could be months or years.

Hormones are linked to migraine attacks, but it’s the changes in hormone levels, rather than the amount of hormones themselves, that matter most, according to the American Migraine Foundation.

For example, if a drop in estrogen is rapid, such as right before a menstrual cycle, the likelihood of developing a migraine episode increases.

A 2021 review of 19 studies found a link between estrogen withdrawal and migraine, with the greatest impact occurring when estrogen levels fell below 45–50 picograms per milliliter (pg/mL).

The review also concluded that not all people experience the same effect, and more research is needed to examine these differences.

Hormonal changes in pregnancy have a similar effect. During pregnancy, estrogen levels increase, and most people experience fewer migraine attacks. However, after pregnancy, estrogen levels drop, and episodes can return.

Even though your estrogen levels decrease in menopause, so do the big hormonal fluctuations. It’s for this reason that migraine attacks usually occur less frequently. It can take several years after the start of menopause for hormones to fully settle, but once they do, migraine episodes stop occurring for many people.

While hormones can trigger migraine symptoms at any point in your reproductive years, perimenopause might be the time you’re most impacted. This is because hormonal fluctuations are more pronounced than ever and can change frequently.

Migraine symptoms tend to improve once you reach menopause.

Some research suggests that hormone replacement therapy (HRT) may worsen migraine.

HRT is commonly prescribed to help with symptoms of perimenopause and menopause, especially for people who experience menopause before 45 years old. This includes estrogen patches or pills.

A 2015 review of studies have concluded that HRT can worsen migraine symptoms, while others have found the opposite. Some evidence suggests that HRT patches may be less likely to make migraine worse than pills, but more research is needed.

If you’re interested in HRT for menopausal symptoms and you also have migraine, talk with a doctor about the risks and benefits either in person or virtually. If you have migraine with aura, HRT might have additional negative effects, including possible worsening of aura symptoms and added cardiovascular risk.

If your migraine episodes become more severe or frequent during perimenopause, a doctor may recommend medication to prevent or treat episodes.

These may include:

  • acute treatments taken at the first sign of a migraine episode
  • preventive treatments taken regularly
  • antidepressants, if you have both depression and migraine

A doctor may also recommend lifestyle changes, such as:

  • reducing exposure to migraine triggers
  • staying hydrated
  • getting enough sleep
  • reducing caffeine or screentime

You may recognize the symptoms of an oncoming migraine attack. But sometimes headaches can be a sign of a serious medical issue that needs urgent treatment. Talk with a doctor and seek immediate medical attention if your headache:

  • is worse or very different than any other you’ve ever had
  • occurs with slurred speech or difficulty speaking
  • causes one-sided facial drooping
  • appears suddenly
  • occurs with confusion, weakness, or dizziness
  • wakes you from sleep
  • accompanies unexplained weight loss
  • occurs with rash or fever

What does a perimenopause migraine feel like?

A migraine attack during perimenopause can feel like migraine attacks you experience at other times. They can include throbbing head pain that may occur on one side of the head, sensitivity to light or sound, and nausea. Some people may also experience aura or visual disturbances.

How do you stop perimenopause migraine?

While perimenopause may worsen migraine or lead to more frequent episodes, a doctor can prescribe medications and other therapies to stop attacks or help prevent them if needed.

Episodes may become less frequent once you reach menopause.

Are migraine episodes common during perimenopause?

Perimenopause can increase the frequency and severity of migraine episodes due to hormonal fluctuations.

What does a hormonal migraine feel like?

A hormonal migraine can feel like a throbbing headache that affects one or both sides of the head and typically occurs with other symptoms, like light or sound sensitivity, nausea, or muscle pain.

Hormonal changes are one of the many triggers of migraine episodes.

During perimenopause, your migraine episodes may get worse due to changing hormone levels, especially of estrogen and progesterone.

For many people, menopause brings relief in the form of reduced migraine symptoms. This is especially true if you have menstrual migraine.