Migraines are very common, affecting approximately 1 in 7 people, and are 3 times more common in women than men. Headaches can sometimes appear and become intense during perimenopause, adding to other annoying symptoms such as night sweats, mood swings and hot flashes. Dr Lowri Bailey, General Practitioner at New Victoria Hospital, talks about migraines and how to treat them during perimenopause.

What can trigger a migraine?

We know that there are a lot of possible triggers and that these can vary from person to person. Some common triggers are dehydration, certain foods, skipping meals/fluctuation in sugar levels, stress, lack of sleep, caffeine and alcohol, but there are many others.

Sometimes, they have a genetic link and often run in families. They are not “just a headache” and can have many other symptoms, which can often be debilitating and stop you from being able to work or function normally.

The oestrogen link

Migraines are also known to be triggered by fluctuations in hormone levels and, in particular, decreases in the female hormone, oestrogen. Many women will experience migraines when oestrogen levels drop in the run up to their period or in the pill-free week when on the combined contraceptive pill.

What about migraines as women approach menopause – the perimenopause?

The perimenopause is the period of time before the menopause when women may experience some menopausal symptoms. During this time period, the female hormones oestrogen and progesterone can fluctuate greatly, causing a wide range of symptoms. We know that perimenopause can last for many years and will typically affect women in their 40s.

As mentioned above, fluctuations in hormones are known to trigger migraines. In addition, many symptoms of the menopause, eg poor sleep, stress and anxiety, can also independently exacerbate attacks. 

It is not surprising that the 40s are often described as the “worst decade” for women who are migraine sufferers!

What can you do control migraines during perimenopause?

Lifestyle factors are essential and many of the approaches for managing migraines are also helpful for controlling symptoms of the perimenopause:

  • Eating a balanced diet and focusing on foods that release sugar slowly
  • Ensuring good sleep patterns are followed daily
  • Exercising regularly
  • Managing and reducing stress

Many women find that decreasing caffeine and alcohol intake will help. It is also essential to drink adequate water and avoid dehydration.

Can hormone replacement therapy (HRT) help with my migraines?

HRT can be very helpful in managing hormone fluctuations and replacing the decrease in oestrogen, which may be aggravating the migraines.

Often women think that they are unable to take HRT as they have migraine, especially if they have been told that there are not able to take the combined pill.

In fact, HRT is NOT restricted due to migraine, although it will usually be started in a low dose and increased very gradually in order to avoid any rapid changes in the hormone levels.

It is important to discuss an individualised HRT regimen based on your other medical and family history with your GP or Consultant Gynaecologist.

If you are experiencing migraines in relation to menopause, you can speak with our GPs by booking your appointment online

Our Private GP Service is open 6 days a week; same-day appointments are also available. New Victoria Hospital has also a free parking space and an on-site pharmacy.


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