Migraine symptoms are varied, ranging from mild to debilitating, with many different causes. One common trigger is hormonal changes.

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

Perimenopause is the transition period between a person’s reproductive period and menopause.

Some people start perimenopause as early as their late 30s, although it typically begins in your 40s. Pregnancy is still possible during perimenopause, but it’s less likely.

Here’s how perimenopause fits into the natural reproductive life cycle:

  1. Menarche. This marks when you have your first period, which signals the beginning of menstruation, usually between ages 9 and 15 years old. The average age of menarche is 12.4 years.
  2. Reproductive period. These are the years during which regular ovulation and menstruation occur, and a person is most likely to become pregnant.
  3. Perimenopause. This is the last stage of the reproductive period and marks the transition to menopause. It lasts for 2 to 8 years and usually starts in your 40s.
  4. Menopause. 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


For some people, the onset of puberty and its associated hormone changes marks the start of migraine headaches. So it’s no surprise that midlife hormonal changes can also affect migraine.

Perimenopause is a time of unpredictable hormone fluctuation. Your levels of estrogen and progesterone can change 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 are triggered by the change in hormone levels before each menstrual cycle.


Once perimenopause is over and menopause begins, migraine attacks tend to decrease for many people. In one review of studies, researchers found that as many as 50 to 60 percent of people saw improvement in migraine symptoms after natural menopause.

However, for some, migraine worsens at menopause, and researchers aren’t sure why.

The type of menopause you have seems to play a role. Research indicates that natural menopause is linked to migraine improvement more often than surgical menopause.

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.

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 to 50 picograms per milliliter (pg/mL).

The review also concluded that not all women 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 headaches 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 unpredictably.

The good news is that for most people, migraine headaches tend to get better once they reach menopause.

It’s not exactly clear what effects hormone replacement therapy (HRT) has on 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.

Several 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 your doctor about the risks and benefits. If you have migraine with aura, HRT might have additional negative effects, including possible worsening of aura symptoms and added cardiovascular risk.

Most headaches are harmless, but sometimes they can be a sign of a serious medical issue that needs prompt treatment. See a doctor 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

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

During perimenopause — a period that generally lasts 2 to 8 years — your migraine headaches 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.