How to Stop Perimenopausal Migraines - Ellen Dolgen
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How to Stop Perimenopausal Migraines

It’s the middle of the day and you’re on your back with the blinds closed, a wet washcloth over your eyes, and a nauseated feeling in the pit of your stomach. What’s that got to do with perimenopause? In a word: hormones.

About 13 percent of adults in the United States suffer from migraines—that’s 35 million people, according to Susan Hutchinson, M.D., director of the Orange County Migraine & Headache Center in Irvine, California. It turns out, 27 million of those migraine sufferers are of the fairer sex. While migraines are about equally prevalent in boys and girls, after puberty, the ratio of migraine occurrence tips to 3:1, with the ladies losing out big time, Dr. Hutchinson says. In fact, girls are more likely to have their first migraine during the year of their first period than at any other time in their lives, according to the Migraine Research Foundation. Why? Again, hormones.

Migraines, unlike other headaches, are often hormonal in nature, so intense fluctuations of hormones (especially estrogen!) in women can egg on and worsen migraines, she says. What’s more, when going through “the change,” many women report elevated levels of stress. Between hot flashes, mood swings, and flat-out life as you know it, how could you not suffer perimenopausal stress? Of course, that stress can further exacerbate migraine symptoms, according to Dr. Hutchinson.

For women, migraines are often marked by throbbing pain that’s worse on one side of the head, nausea, vomiting, and sensitivity to light and noise. For those women who have migraines with aura, those symptoms are often prefaced by seeing flashing lights and floating lines, developing temporary peripheral blindness, experiencing numbness or tingling in the face or hands, suffering a distorted sense of smell, taste, or touch, and experiencing mental confusion.

While migraines typically last for anywhere from four to 72 hours, when shifting hormones are to blame, they tend to run the long side, notes Dr. Hutchinson. “My speculation is that, often, the underlying hormonal trigger continues to be present unlike, for example, a migraine caused by a food trigger that is ingested, causes a migraine, and then is no longer ingested so the trigger does not continue to be present,” she says.

The silver lining is that two-thirds of female migraine sufferers completely ditch their migraines or notice marked improvement when they enter menopause, a time in which hormones finally stop fluctuating. In fact, after age 60, only 5 percent of women suffer migraines, according to the Migraine Research Foundation.

Still, the problem for many women is getting through the hell of perimenopausal migraines to the bright light of menopause.

Not anymore! Put the pain in the past and get your life back with these three tips perimenopausal migraine-relief tips from Dr. Hutchinson:

Find a Specialist
As with most things medical, visiting a trained specialist is a solid first step. Your perimenopause and menopause specialist can evaluate your migraines in relation to your hormonal status and adjust hormone therapy if necessary, says Dr. Hutchinson, who notes the importance of also finding a good headache and migraine specialist who is versed in how fluctuating hormone levels affect migraines. Your best bet? Ask your perimenopause and menopause specialist for a referral or look for local M.D.s on or, she says.

Consider Non-Oral Bio-Identical HT (Hormone Therapy)
Whether you are on hormone therapy or are just thinking about taking the plunge, talk to your perimenopause and menopause specialist about how HT can influence perimenopausal migraines—both for good and for bad. Remember: “All forms of HT are not created equal,” Dr. Hutchinson says. “If HT is used, the general consensus in the ‘headache world’ is to use a non-oral delivery system such as the estradiol transdermal patch and oral progesterone. Especially in a woman with a migraine with an aura.I like “bio-identical” meaning that the estrogen and progesterone would have the same chemical structure as a woman’s own ovaries and would be more likely to help a migraine than hurt.  Once HT is started I would advise the woman to watch the pattern of her headaches and aura carefully and report any marked increase to her treating provider.

On a synthetic, oral pill? It might actually be worsening your migraines! “Oral preparations have more variability in absorption and blood levels and therefore would be predicted to not be as helpful in treating/preventing menopausal migraine. Synthetic and oral preparations are more likely to cause or aggravate a headache,” Dr. Hutchinson says.

Fight Your Triggers
Apart from hormone fluctuations, bright or flashing lights, a lack of food or sleep, and stress can all contribute to migraines. Your best defense is good self-care. Dr. Hutchinson advises eating small, frequent meals throughout the day that pack both complex carbohydrates (think: whole grains, legumes, and starchy vegetables) and protein to regulate blood sugar levels. Dietary supplements including butterbur, B-2 (riboflavin), coenzyme Q-10, and magnesium can also be helpful in migraine prevention, according to Dr. Hutchinson. Make sure to drink plenty of water, as dehydration can cause headaches. Remember: if you feel “thirsty,” you are already dehydrated, according to the National Health Service. Getting a full night’s sleep and exercising regularly (which can help you sleep better!), can also help. Last but not least, don’t smoke! You also might want to cut back on the caffeine and booze, she says.

Don’t let perimenopause be a pain—figuratively or literally! A happy head is vital to being the productive and fulfilled women that we are destined to be.

Remember: Reaching out is IN! Suffering in silence is OUT!

For more great tips on how to find a menopause specialist and deal with menopause, download my free eBook: MENOPAUSE MONDAYS  the Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause.    

Be sure to sign up for my fun YouTube Videos!



40 thoughts on “How to Stop Perimenopausal Migraines”

  1. I seem to be having these migraines….wonder if anyone is having these without the “headache” part..I have pressure behind the eyes with the sensitivity to lights/noise, nausea at times.

  2. I’ve suffered from migraines all my life and they definitely got much worse when I was in perimenopause. I couldn’t wait to reach menopause so I could finally be done with them, like my mother was and everything I read told me. While I was one of the 1/3 that did not get rid of them. They are not as bad as the perimenopausal state, but bad enough.

  3. So sorry to hear this Jennifer. Have you thought about trying HRT…many women find relief really quickly. Also, sign up for this months Giveaway of Dr. Hutchinson’s wonderful book. She has some great tips on how to minimize disruptions that can trigger a headache.

  4. Yes i get migraines! I think the barometric pressure effects me. So if we have a fast weather change I can get a migraine. In reading some diaries of pioneers finding skulls with holes in their skulls, I always think it must have been a bad migraine.

  5. Wow, as usual I learned something new in your post Ellen! I did not realize that there were hormone triggers for migraines! This could really provide some hope and relief for those who can identify that trigger! Thanks so much for sharing this important piece of information!

  6. I don’t get migraines but I definitely get headaches. They seem to be stopping now that I really seem to be in menopause instead of the endless perimenopause. Thanks for all the great information here.

  7. This was extremely helpful. I get migraines and am looking forward to the day when they stop, like my mothers did. Passing this on to share with many friends who are in the same boat. Thanks for being such a great resource!

  8. I’m 49 and I agree with all you’re saying. I was on a low synthetic estrogen/progestin pill in my 30’s. I had to go off of it because my auras were so bad I felt like I was on some psychotic drug. Since being off of that the aura has declined but they still occur within a few days of my cycle which is more regular now than it ever was. I get severe nausea but the headache is not incompacitating. I also get an earache on the same side as the headache. The eye runs and my nose runs on that side with a burning sensation that follows up behind my eye. I do have luck with Black Cohosh, Feverfew and NSAIDS. Sometimes a little coffee helps. When coffee doesn’t a glass of wine will. This is the vaso-constriction vs vaso-dialation thing. If I add a few drops of peppermint oil to a cup of hot tea that seems to reduce the nausea. I hate wasting time with a migraine it has a disorienting effect that makes me feel stupid. I don’t like to be at work during these since I’m in a science field. I can’t speak correctly sometimes and it make you look stupid. Anyways I hope some of this could help others. Thanks for sharing yourself with the rest of us!

    1. Wow, Ruth, you have had a time of of it. Thanks for sharing some of the things that have helped you! The sisterhood helping the sisterhood….I love that!

  9. I’m 39 and had my first child at 30, while I had migraines pre puberty, the stopped completely in my teen years. However since I had my child 9 years ago, I have been struggling ever since, the vomiting and not being able to eat or drink it is the worst part, because I have actually dehydrated myself, and had to make a ER visit. I am not trying seasonale, first week on it, and praying it helps. Seriously I can not hold a job, because of the amt of times I need to call in. It’s so bad that I have thought about getting a full hysterectomy just to put my body into menapause.Ugh, good luck to all.

    1. So sorry you are going through so much. Before you get a full hysterectomy — YIKES! Please consider going to a migraine specialist. This doctor may be able to understand the nature/cause of your migraines and create an individual program just for you.

  10. Ellen,

    Found your article when looking for help for my wife. She’s 49 and has been having migraines 24/7 now for about 8 months or so. She currently taking an oral migraine prescription (topiramate) and just had an MRI. the MRI didn’t show anything of any concern, but did show evidence of the migraines.

    Just wondering, have you heard of any other women having constant migraines for several months at a time? My wife’s seem to vary in intensity, but she hasn’t been pain free for quite a while. She sees the neurologist in a couple of weeks, but we’re now wondering about HRT – although we’re also concerned with the increased risk of breast cancer associated with HRT.

    1. I am so sorry your wife is going through so much. Is your wife currently on the pill? Perimenopause is the 2 – 10 years before a women is in menopause. Menopause is when a woman has been without a period for 12 consecutive months. The average age of menopause is 51years old. So, it is very possible that your wife’s hormones are contributed to her migraines. I would definitely seek out a good menopause specialist and have a detailed hormonal panel done. Take a look at this Dear Ellen for some tips and tools on how to find a good specialist. You can find a list of the tests to ask for in this Dear Ellen. Good Luck and keep me posted!

      1. Thanks for your reply.

        No, she is not currently on the pill. She did when she was younger, but went off when she was about 32. She sees the neurologist in a couple of weeks, and I think is schedule for her annual gyn visit in Dec, so we’re still deciding what our next step should be.

  11. Do you hear much from women about electric flashes or pulses in the head? I’ve read this could be menopausal related. I am 45 and entered perimenopausal territory over the past year. The migraines and constant nausea have been the worst part. While the head pulses are not painful, they are disturbing. Any thoughts?

    1. Cynthia, you can see from the research in this Health New Flash that migraines can get worse in the years before and during menopause. I would definitely go to see a menopause specialist. If you don’t have one, I have some tips on how to find one in this Dear Ellen. Also, if you find you need a migraine specialist, I have a link in this Dear Ellen that may help you. Do NOT give up until you get the help you need and deserve! Keep me posted!!!

  12. I have had migraines since puberty. Got worse when I was 32. I will be 49 in June. For the past six months, my periods are coming closer together — every 19 days. This past month, I had the shortest period I ever had in my life — 3.5 days. I always had bad PMS – mood swings, migraines, the need to scarf down as much chocolate I could find. Well now my PMS is coming twice a month. And my mood swings — which used to last for 1 or 2 days per month — are now lasting about 4 days twice a month! So I am losing an entire week due to weeping or anger. Sometimes I wake up out of my sleep –breathless (I am not kidding!) and realize oh no — I am going through menopause. I am old! And all the mistakes I have made in my life are rushing through my brain and I cry and cry. I feel like the reaction to all of this is — yup. You’re in perimenopause. No big deal. But my God, it feels like such a big deal to me. The migraines and PMS are the worst. They steal time from me. Time I don’t want to waste. Help!

    1. CeeCee, I am sorry you are having such a difficult time. I did, too! You definitely need to find a good Menopause Specialist so that you can get on an individualized plan that works just for you! I have some tips on how to find one in the Dear Ellen. You can find some tips on what tests to ask for here. Download my free Menopause Symptoms Chart here. Fill this out each night for a couple of weeks. This will really help your Menopause Specialist understand how you feel – quickly and accurately. There are lots of options to help you with menopause symptoms ranging from bioidentical hormones to non hormonal options. You can find some info in this Dear Ellen. If you think all hormone therapy is the same, then I recommend that you read about the latest information/studies here. I know this is a lot of info, but knowledge is power! I want you to be well informed on your options so that you can advocate with your specialist. You do not need to suffer! Good luck and keep me posted!

  13. Hello Ellen,

    Great article, although I’m reading it through my foggy migraine brain. I started having hormone migraines about 2 years ago. I’m on a low dose BC pill and take rizatriptan during my period. I take the first pill no later than Monday of that week. If I can stay on top of it, I can be almost functional. :-/ But I do max out the dose and take ibruprofen. But it can still feel like I lose the week. And the mood swings, ugh.

    I don’t currently have a good program for supplements and would be interested in your advice there.


    1. Jenny, I am so sorry that you are suffering with these migraines. I know many people, including my husband, who have found tremendous help with TM (Transcendental Meditation). You can go to a couple of classes and learn to meditate on your own for 20 min – twice a day. It is worth a try! David and I went together. If you aren’t already going to a migraine specialist, I would definitely find one. This specialist should be able to advice you on supplements. Here are some sites to help you find a specialist: or

  14. Hi there. I had had migraines since I was 28. I am not 52, and they are ruining my life. I get them every 2 weeks for 3 days… and sometimes more. I also have headaches when not migraining. I cannot work, cannot plan anything… they are so painful i just have to go to bed. I am getting hot flushes now, so thinking hopefully I am getting close to menopause. I am concerned you advocate HRT… or am i misunderstanding you perhaps? Is there another HRT that doesn’t cause cancer and has nasty side effects? I have had two of my friends take HRT and both got cancer. I wish I had a migraine specialist where I live, but Dr’s here are hopeless. Just give you drugs that don’t work, so now i don’t take drugs when my migraine comes.. Just ride it out as drugs seem to make it worse, not better. I took the triptans for awhile and was ending up with 2-3 migraines a week and ended up in the ER with the pain. I just use anti inflams when desperate. Be good to hear your comments on the HRT…

    1. Tracy, I am so sorry you are going through so much. If you don’t have a good menopause specialist check out this Dear Ellen for some tips on how to find one. There is a lot of research that has been done on hormone therapy since 2002. I am not a doctor or a scientist, however, I do try to interview the smartest and the brightest in the field so that we can all understand the latest information. I want women to base their healthcare on facts instead of fear. There are different kinds of hormone therapy, as well. There is bioidentical HT vs non-bioidentical HT. To learn more about this new research read this Dear Ellen. In my blog on migraines, Dr. Hutchinson suggested two links to help you can find a migraine specialist: or I strongly reccommend trying TM. This is enormously helpful for reducing stress. I have heard from many people that it has reduced their migraines in half! Good luck and keep me posted!

    2. Hi Tracy

      I am 49 years old and have been entering the world of perimenapause. In the last 6 months I began developing migraines the week before my period was to begin. Even if I didn’t get a period I was getting migraines.
      I went to my Dr and described the pain and pressure this was causing me. She suggested I try Spironolactone 25 mg. This is essentially a water pill. And when I take 2 at a time I must tell you they work. If I miss them or underestimate their power I am in bed until I take them and they begin to work their magic.
      I also use a progesterone cream the other 3 weeks out of the month and I use DoTerra essential oil (clary clam) 2 times a day every day for hot flashes. The hot flashes are quite controlled.
      I hope this helps:)

    3. I feel your pain Tracy… quite literally, as I have a migraine now… I typically get a migraine once a month for 3 to 4 days. In the earlier days they would completely floor me. Now they are still unpleasant, but generally i can operate at about 70 to 80%. I tried everything natural, but not interested in drugs and hormone therapy. Most recently I got daith ear piercing, as I heard from some sufferers that it helps. I didn’t notice much difference myself.. Pain drugs never had any effect on my migraines, so I just ride it out until it magically suddenly lifts. I do take magnesium, vit B, Co enzyme Q10 and maca powder, as well as powdered ginger to try to help. My periods have stopped over a year ago now. I’m the same age as you (56 2019). As I said, my migraines are not as intense as they used to be, for what ever reason… I still have hot flushes also, but I’d take them any day over a migraine! I’ll be glad when/if I leave the migraines behind altogether… I hope you have improved now.

  15. I am the medical canoe who is up a creek without a paddle in this situation, I am a 43 year old single mother, who started having perimenopausal migraines last year; I also suffer from epilepsy since I was 21, and most of my migraine auras are very similar to my seizure auras, which very much complicates for me when I should “try and ride out the headache”, and seriously stop and seek rest and medical treatment right away. Oh, and because my body has a mad sense of humor (or at least the Man Upstairs does, if you believe in Him, haha), I also was born with not one, but two actual blood clotting disorders, which have ruled out any type of hormonal treatments in my body for years (I couldn’t even touch most modern types of birth control). So I am unable to ease the migraines, which I used to get when I was in my teens as well, but went away, with any type of HRT. I am getting severely depressed, mostly because I cannot support my son this way, not being able to hold a job when I always get a crippling, bedridden headache that lasts for anywhere between 5-12 days (yes, they go that long for me). I’ve lost several jobs now, due to attendance
    issues, and now am researching the dreaded word “disability”. But I’m 43…… and who in the heck wants to admit they are disabled at 43, due to issue that I’m sure will be laughed out of the filing office anyway. Yeah, I can claim mental issues, but then I set myself up to lose my child. All of this, because I turned 42 last year????? I agree, I don’t understand it, I don’t why, I can’t control any facet of it, and it is leaving ME in a very particular rock and hard place. I’m sure many other women face issues like mine. If any have answers, PLEASE, I am desperate for any advice, even just a word of encouragement that it will get better.

  16. hello, I just turned 50, I am in perimenopause and also have hemiplegic migraines, I am taking elavil for migraine prevention and it works pretty well except when I get my period, at some point before, during or just after I will get a migraine, I am going to be starting a progesterone cream soon, but I am confused about the estrogen and progesterone thing, is the progesterone what I need? I have not had blood work, diagnosed by age and symptoms

    1. I am so sorry you are dealing with these migraines. I know how difficult they are as my husband has them. I think the most important thing is to find a good menopause specialist to help you determine an individualized program that works for you. I would not start taking progesterone over the counter unless I consult my menopause specialist first. It is never a good idea to self-prescribe. Good Luck and keep me posted!

    1. When we share our menopausal journies, it helps others to gather information to speak with their menopause specialist about! Thanks so much for sharing……

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