There are headaches that gnaw at the base of your spine or throb in your forehead, but pop a couple of aspirin or ibuprofen and you can go about your usual routine. Then there are the monster headaches that derail your whole day, or maybe several days, and no over-the-counter pain relievers make a dent on them. These are migraines, and they can be a real pain for women going through perimenopause and menopause. In fact, some people get them so bad, they become extremely sensitive to light and become sick to their stomach.

Research confirms what women with migraine headaches have told their doctors for years: migraine headaches heat up as women approach menopause.  According to a study by researchers at the University of Cincinnati (UC), Montefiore Headache Center, Albert Einstein College of Medicine and Vedanta Research, about 12 percent of Americans get migraines and women get them three times more often than men.

According to Dr. Susan Hutchinson, director of the Orange County Migraine & Headache Center in Irvine, California, migraines, unlike other headaches, are often hormonal in nature, so intense fluctuations of hormones, especially estrogen, in women can egg on and worsen migraines. The silver lining is that two-thirds of female migraine sufferers notice a 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.

Dr. Hutchinson is the author of The Women’s Guide to Managing Migraine Understanding the Hormone Connection to find Hope and Wellness published by Oxford University Press.

Here are some helpful tips for managing your migraines:

Find a Specialist

As with most things medical, visiting a trained specialist is a solid first step. Your Menopause Specialist can evaluate your migraines in relation to your hormonal status. You may find that you need hormone therapy or if you are already on HT, you may need to have it adjusted. If you find that your HT is not doing the trick, it is time to find a good headache and migraine specialist who is versed in how fluctuating hormone levels affect migraines. Ask your menopause specialist for a referral or look for local doctors at the National Headache Foundation or American Headache Society.

Consider Non-Oral Bioidentical HT

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. It would be expected to help prevent a migraine as it provides an even level of estradiol and is the same chemical structure as the estrogen/estradiol that a woman’s ovaries produce prior to menopause.”

On a synthetic, oral pill? It might actually be worsening your migraines.

“If hormonal therapy is used in perimenopause and menopause in women with a migraine, bioidentical is better: fewer side-effects and less likely to aggravate migraines.  Synthetic HT such as found in birth control has a higher chance of making a woman’s migraines worse. The choice may come down to whether birth control is needed in the perimenopausal woman who could still get pregnant. If birth control is not needed in a perimenopausal woman, then bioidentical hormones especially non-oral are my preferred treatment,” Dr. Hutchinson explains.

Fight Your Triggers

Dr. Hutchinson speaks to the importance of getting a full night’s sleep and exercising regularly (which can help you sleep better!).  She 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 and suggests the following dietary supplements can be helpful in migraine prevention:  butterbur, B-2 (riboflavin), coenzyme Q-10, and magnesium. Make sure to drink plenty of water, as dehydration can cause headaches.

Apart from hormone fluctuations, bright or flashing lights, a lack of food or sleep, and stress can all contribute to migraines, according to the North American Menopause Society. Your best defense is good self-care.

Stephanie Weaver, MPH, has been exploring the link between a migraine, nutrition and other lifestyle factors since being diagnosed in 2014 with migraines and vertigo.  While migraines often ease after menopause, in Weaver’s case it worsened, leading her to a midlife diagnosis.

Weaver suggests, “Since a migraine is an inflammatory process, our Migraine Relief Plan reduces inflammation by removing processed food, gluten, and sugar. We give you dairy-free options for most of our recipes, as dairy can be inflammatory for many people. We recommend high-quality healthy fats like extra-virgin olive and coconut oil, and grass-fed/pastured animals as well as wild-caught fish.”

Check out her FAQ page for more helpful information. Her book, The Migraine Relief Plan, will be released in Spring 2017 by Agate Publishing.

So, if 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—do not suffer in silence. Find the solution that works for you.

My Motto:  Suffering in silence is OUT!  Reaching out is IN!

Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend’s Guide To Surviving and Thriving During Perimenopause and Menopause.