Are my headaches connected to perimenopause or menopause?

Many women notice that their headaches or migraines change during their 40s and 50s, often becoming more frequent, more intense, or harder to predict. This can happen even if headaches were never a problem before.

These changes are commonly linked to perimenopause and menopause, when hormone levels fluctuate and then eventually stabilise. Understanding why this happens can help explain what you’re experiencing and what may help.

In this article, I explain why headaches and migraines often change during perimenopause and menopause, what menopause-related headaches feel like, what can trigger them, how to get relief, and when headaches should be checked by a specialist.

Why have my headaches or migraines changed during perimenopause or menopause?

Perimenopause is the transition leading up to your final menstrual period. Menopause is defined once you have gone 12 months without a period. During this transition, hormone levels (particularly oestrogen) fluctuate significantly.

During perimenopause, periods can become heavier, more painful, and more frequent, and this hormonal instability is linked to headaches and migraines becoming more frequent or more severe. Although the exact mechanism isn’t fully understood, it is thought that erratic oestrogen levels play a key role in triggering changes in headaches and migraines.

Can menopause cause new headaches if I’ve never had migraines before?

Menopause can cause new headaches, even in women who have never experienced migraines before.

It is very common for women to experience headaches during the menopause transition. Headaches often worsen in the years leading up to menopause, and then improve a few years after periods stop, once hormone levels stabilise again.

Fluctuating oestrogen levels can both trigger new headaches and worsen pre-existing headaches or migraines.

What do menopause headaches or migraines feel like?

Menopause-related headaches can vary in how they feel.

Some women describe:

• A dull, pressure-like ache
• A sensation of a tight band around the head

Menopause-related migraines tend to be more intense than a typical headache. Symptoms may include:

• Throbbing pain, often on one side of the head or behind one eye
• Nausea or vomiting
• Sensitivity to light or sound
• Tiredness or dizziness

What makes menopause headaches and migraines different from usual headaches is that they are triggered or intensified by hormone fluctuations, particularly around the menstrual cycle and during the menopause transition.

What can trigger headaches during perimenopause or menopause?

The main trigger for headaches during perimenopause and menopause is erratic fluctuation in oestrogen levels. As a result, headaches may become more frequent and last longer.

Other common contributing factors include:

• Poor sleep due to hot flushes and night sweats
• Tiredness
• Skipping meals
• Dehydration
• Caffeine
• Alcohol

Why are headaches worse at night or first thing in the morning during menopause?

Many women find that menopause-related headaches are worse at night or on waking in the morning.

This is usually due to a combination of factors:

• Night sweats and hot flushes disrupting sleep, leading to headaches on waking
• A drop in oestrogen levels overnight, which can trigger headaches during the night or early morning

What can help with quick relief from menopause-related headaches?

Options for quick relief include:

• Painkillers such as aspirin, ibuprofen, or paracetamol
• Anti-sickness medication, taken alongside painkillers if nausea or vomiting is present

For migraines, triptans are a group of medications used specifically for acute migraine treatment. Some are available over the counter, while others require a prescription. They come in different forms, including tablets, nasal sprays, dissolvable tablets, and injections.

It may take time to find the most effective option, and some women need to try different medications or combinations.

Other supportive measures that may help include:

• Resting in a dark, quiet room
• Applying a cool pack to the head
• Ensuring you are well hydrated
• Using deep breathing exercises to help calm the nervous system

Can HRT make menopause headaches better or worse?

Many women who experience headaches or migraines during menopause also have significant hot flushes and night sweats. Hormone replacement therapy (HRT) is very effective at improving these symptoms and, by doing so, can also improve headaches.

HRT can help by stabilising hormone fluctuations that trigger headaches and migraines.

For women with migraines, especially those who experience migraine with aura (temporary neurological symptoms that can occur before or during a migraine, such as flashing lights, zig-zag patterns in vision, tingling, or brief speech difficulties), it is generally recommended to use transdermal oestrogen, such as patches, gels, or sprays.

Key points include:

• Starting with a low dose, as headaches can initially worsen
• Allowing time for the body to adjust to steady hormone levels
• Increasing doses slowly if needed for ongoing symptoms
• Waiting up to three months to assess full benefit before changing dose

Oral oestrogen (tablets) can increase the frequency and duration of migraine attacks, so transdermal options are usually preferred.

When should menopause-related headaches be checked urgently?

Serious causes of headaches are rare, but certain symptoms should be checked urgently by a specialist.

Red flag symptoms include:

• A new, severe headache that becomes intense very quickly
• A headache that is progressive or persistent over days or weeks
• Headache with fever, neck stiffness, drowsiness, or a rash
• New neurological symptoms, such as confusion, limb weakness, double vision, or balance problems
• A new persistent headache with unexpected weight loss or a past history of cancer

If any of these occur, urgent specialist assessment is important.

About the author

Dr Ashlesha Dhairyawan is a highly experienced Menopause Specialist based in London, with over 20 years of expertise in women’s health and menopause care. A British Menopause Society–accredited Menopause Specialist, she practises privately at Medical Prime Menopause Clinic in Central London, providing personalised, evidence-based support for menopause, HRT, osteoporosis, and sexual health, with a strong focus on empowering women through the menopausal transition.