Menopause headaches: Why they happen and what can help

Ever had that nagging feeling that something isn’t quite right? That the day just feels so much harder. And then it dawns on you — you’ve been carrying around a splitting headache since morning and it simply won’t budge. Headaches can be a real, well, pain and can be caused by all sorts of things, including poor sleep, stress, and your environment. 

And they can also be caused by the menopause transition. Fluctuations in female sex hormone levels (including estrogen and progesterone) can influence the frequency and severity of menopause headaches and migraines. 

This article will explore the connection between menopause and headaches, help you to recognize patterns in your symptoms, and explore potential treatments that you can discuss with your clinician.

There are many types of headaches, each with their own sensations. These two are the most common:

• A ‘tension’ headache is characterized by pain and discomfort in the head, scalp, or neck. It’s often associated with muscle tension in the face, neck, and shoulders.

• A migraine is a recurring form of headache. It can cause moderate-to-severe pain, often on the side of your head, that feels like it’s pulsing or throbbing. You may feel weak and nauseous, or sensitive to light and sound. Around 12% of Americans encounter migraines.

Throughout your life, you experience fluctuations in the female sex hormones estrogen and progesterone. They go up and down depending on your menstrual cycle, whether you’re pregnant, and whether you’ve entered the menopause transition. These fluctuations can affect the frequency and intensity of headaches during your lifetime — both positively and negatively. For instance, nearly 60% of women who experience migraines report a link with their menstrual cycle. 

And then there’s the connection between headaches and menopause. You may notice an increase in migraines around the time you enter perimenopause. This is likely associated with hormonal fluctuations, but it’s only partly understood why this happens. Estrogens and progestins have a complex interchange with oxytocin. As you transition into menopause, oxytocin levels decrease, and your susceptibility to mood disorders, poor sleep, osteoporosis, and other issues increases. Studies suggest that a fall in plasma levels of oxytocin may trigger migraine attacks, but this is still being investigated. 

Tension headaches can also be challenging during this time, as a result of the stress and anxiety related to the menopause transition. Sleep problems related to menopause, like insomnia or night sweats, can also contribute to this, and fatigue and poor sleep may trigger headaches and migraines.

As upsetting as headaches and migraines can be, know that it won’t always be this way: Many women report experiencing a lot fewer migraines after menopause.

How clinicians think about type, frequency, and impact of menopause headaches

If you’re enduring menopause headaches every day, it’s best to speak to a medical professional. Make an appointment with your clinician to discuss your symptoms and share your symptom log to help devise the best prevention plan.

To determine whether your headaches are related to perimenopause or menopause, your clinician will ask about your symptoms, cycle, and how frequently you’re experiencing head pain or migraines. They will want to know how headaches are impacting your day-to-day life and may see how they respond to medications. 

Understanding the root cause of the pain of headaches during perimenopause, or any other time, is essential when figuring out the right treatment plan.

Hormonal fluctuations during menopause — especially the rise and fall of estrogen — can trigger all sorts of symptoms, from hot flashes to sleeping difficulties. And some of these symptoms may contribute to headaches or migraines.

Hormonal headaches and perimenopause 

Drops in estrogen during the menopause transition may lead to an increase in frequency or intensity of migraine attacks. Fluctuating estrogen levels are thought to affect neurotransmitters and other hormones, which may make the brain more sensitive to migraine attacks during this time. Research is very limited in this area, but one study suggests there is a possibility that migraines may worsen due to “estrogen withdrawal.” Heavy menstrual bleeding during perimenoause can lead to an iron deficiency, which has been associated with headaches and fatigue in some studies (though more research is needed to clarify the relationship).

Perimenopause is the lead-up to actual menopause, and it usually occurs when you’re in your 40s. While hormonal fluctuations may directly impact headaches, other symptoms associated with this stage of life may also be triggers. 

• Anxiety and stress: Perimenopause and the menopause transition can be an unsettling time. Studies have identified an increase in anxiety symptoms during perimenopause, which may lead to tension headaches. Potential causes for anxiety, including stress, depressive symptoms, and sleep disturbances, may also overlap with menopausal symptoms. 

• Sleep troubles: It’s estimated that up to 70% of women report sleep difficulties across the menopause transition. You may experience insomnia, night sweats, and difficulty staying asleep. Sleep and fatigue may trigger both headaches and migraines.

Other unrelated triggers may also affect you during this time. For example, poor posture can lead to tension in your neck, shoulders, and upper back, which could lead to headaches. Try to avoid sitting or standing in one place for long periods of time.

If you’re experiencing perimenopause headaches daily, it’s best to speak to your clinician about your discomfort.

Headaches after menopause

After menopause, some people find relief from their menopause headaches, as their hormones stabilize. But hormones can continue to fluctuate for several years into postmenopause, so others may continue to experience headaches. And of course, even after your hormones have stabilized, you may continue to experience migraines or headaches for non-hormonal reasons.

Non-hormonal risk factors for migraines can include:

• Bright or flashing lights

• Strong smells

• Medications

• Too little (or too much) sleep

• Sudden changes in environment

• Overexertion

• Tobacco products

• Caffeine (or caffeine withdrawal)

• Skipped meals

• Certain foods, including alcohol, chocolate, and aged cheeses

Non-hormonal risk factors for tension headaches may include:

• Emotional or physical stress

• Alcohol or caffeine

• Cold, flu, or sinus infection

• Dental problems

• Eye strain

• Excessive smoking

• Fatigue or overexertion

When a headache or migraine is an emergency

Seek emergency care for a headache or migraine if:

• This is the first severe headache you’ve had, and it’s interfering with your daily activities

• The headache comes on straight after exercise or sex

• The headache arrives suddenly or is “explosive”

• The headache is the “worst ever,” even if you experience them regularly

• You have slurred speech, a change in vision, problems moving your limbs, loss of balance, confusion, or memory loss—especially if you haven’t experienced this with a migraine before

• The headache gets worse over 24 hours

• You also have a fever, stiff neck, nausea, and vomiting

• The headache follows a head injury

• The headache is severe in one eye, and comes with redness in that eye

• This is your first headache ever, and you’re in your 50s

• Your headache is accompanied by vision problems, pain while chewing, or weight loss

• You have a history of cancer

• You have a weakened immune system

You should visit your clinician for advice if your headache makes it hard to fall asleep, or wakes you up from sleep. Also, if it’s worse in the morning or lasts more than a few days, seek medical advice. Frequent occurrence and changes in patterns or intensity should also warrant further investigation from a medical professional. 

Bring a symptom log when talking to your clinician about your menopause headaches or migraines. This can help your clinician to identify patterns in your symptoms, help to work out potential triggers, and come up with a treatment plan.

After the fact, it can be hard to remember when you first felt a headache start, what you were doing at the time, and how long it lasted — especially when you’re trying to navigate everything else that menopause throws at you. 

Keep a simple headache diary to keep note of anything that could be worth mentioning to your clinician about your headaches during perimenopause. For example:

• How you slept — if you struggled to get to sleep, woke up several times, or experienced night sweats (this may be helpful if you find you’re waking up with headaches during perimenopause)

• Times you felt stressed 

• Any menstrual changes or menopause symptoms

• How much you drank 

• What meals you ate (to identify potential dietary triggers)

• Whether you noticed any posture issues or neck strain

Your clinician may suggest making one lifestyle change at a time to see what makes a difference.

Morning and wake-up headaches

Morning headaches that occur as soon as you wake up (or shortly after) could have several different causes, from sleep disorders and hypertension to psychological factors. Fluctuations in hormones like cortisol can also trigger morning headaches. Additionally, hormonal shifts related to menopause can be more pronounced in the morning, which may increase the chances of morning migraines or headaches.

Remember to track things like sleep quality, snoring, teeth clenching, caffeine intake, hydration, and vasomotor symptoms to discuss patterns and findings with your clinician.

When deciding on the most appropriate ways to help your menopause-related headaches or migraines, your clinician may recommend lifestyle support, medications to reduce pain, and tips for preventing future headaches. 

Acute treatments that may be recommended include general pain relievers, like NSAIDs and acetaminophen, as well as headache-specific treatments like triptans, lasmiditan, and gepants. Preventive treatments may include beta-blockers or specific drugs designed to prevent migraines. 

Lifestyle recommendations can include adjusting your sleep hygiene or nutrition habits, staying hydrated, and practicing stress management techniques.

Other non-medication treatment options to consider helping with your menopause headaches include:

• Acupuncture

• Vitamin E supplements

• Aerobic exercise

• Black cohosh supplements

• Yoga

Your treatment options may be dependent on your personal risks and medical history and should be done under a clinician’s guidance.

With any menopause treatment plan, make sure to ask your clinician about the risks and benefits of the approach. It’s also important to disclose any supplements or medications you’re taking so your clinician can advise if there could be any potential interactions.

Hormone therapy considerations

Hormone replacement therapy (HRT) is not usually prescribed just for menopause headaches. And HRT may even result in worsening migraines for some people. If you have migraines with aura, taking supplemental estrogen may even increase your risk for ischemic stroke — but this is likely dose-dependent.

If you want to explore HRT for other menopause symptoms, like hot flashes, your clinician is best placed to advise on the most appropriate form of dosage and should inform you of the potential for increased adverse effects.

The physical changes you experience during perimenopause are rooted in hormonal fluctuations. Vasomotor symptoms, like hot flashes and night sweats, are the most common perimenopause symptoms and affect 80% of women. These symptoms can disrupt your sleep and cause anxiety, which may trigger more headaches.

To improve your sleep, you could try:

• Keeping your room at a comfortable temperature by using a fan or sleeping with the windows open

• Taking a cool shower or sipping a cold drink

• Wearing breathable clothing, in layers, that you can remove if you get too hot in the night

• Using lightweight, breathable bedding to help keep you cool

• Avoiding your known triggers before bed — which might include wine, sugary treats, or caffeinated drinks

If you find your morning perimenopause headaches or severe sleep disturbances persist, your clinician may advise screening for sleep disorders. They may also discuss whether you may be a candidate for HRT to help with vasomotor symptoms.

When speaking to your clinician, it’s important to be open and honest about your headaches. Try your best to describe their pattern and impact on your daily life. Share a concise symptom log, including any food triggers and how you slept, so your clinician can try to make connections. 

You should provide your clinician with a list of current medications or supplements so they can determine if any are triggering your headaches as well as ensure that any new prescribed medication won’t have negative interactions.

Ask your clinician about different treatment options for headaches during perimenopause, including both acute and preventive strategies. Acute medications are taken once your headache has started, whereas preventive options are taken to stop the headache from recurring. Don’t be nervous about rephrasing the information your clinician is telling you to check you fully understand and ask for more clarity if you need it. 

Questions to bring to your appointment

Here are some prompts you may wish to take to your menopause headache appointment:

• What type of headache do you think I have?

• How can I prevent overusing pain medication?

• What could be causing my headaches?

• How might my sleep, stress, or neck pain be contributing to this?

• Could my headaches be related to menopause?

• What tests might be needed to diagnose this?

• What are the treatment options?

• What should I do if my symptoms get worse?

When to re-evaluate your plan

Revisit your plan with your clinician if your symptoms or headache patterns change, or if you find your medications are needed more often. If your headaches start impacting your daily life, this is another time to talk with your clinician and change your treatment strategy.

After each menopause care appointment, plan a follow-up to check on how your headaches are doing.

While headaches during menopause can be common, there are plenty of supportive lifestyle strategies and medical treatment options to explore with your clinician. Remember to work closely with a clinician on a personalized plan to alleviate your most bothersome symptoms. 

Weight Watchers Menopause Program offers members resources and nutrition guidance to help you feel empowered and in control of your menopause journey.