Hysterectomy and Migraine: What to Expect

A hysterectomy may aggravate migraine. Learn how to create a migraine treatment plan before surgery.

A hysterectomy is a surgery that removes the uterus and sometimes the ovaries, fallopian tubes, cervix and lymph nodes. In radical hysterectomies, part of the vagina may be excised. If the ovaries are removed, this will cause estrogen levels to drop immediately, and it can trigger symptoms for many women with migraine. If you’re planning a hysterectomy, be sure to discuss with your doctor about the surgery, post-operation care and how your own procedure will go. Once you understand how hormones affect migraine and your options for treatment after the surgery, you can plan ahead.

Menstrual Migraine and the Hormonal Cycle

The menstrual cycle happens about every 28 days for most females and is a series of hormonal ups and downs. Estrogen, progesterone and other hormones are chemicals that direct tasks throughout the cycle. When hormone levels change, especially estrogen, migraine symptoms can become more intense and frequent, causing menstrual migraine.

Your cycle begins on the first day of your period. At that time, estrogen is low until day four or five. It then creeps up until about day 14, when it drops again. After a few days, estrogen levels increase once more. A steep decline starts around day 25, staying low for several days.

This estrogen roller coaster causes intense symptoms for women with menstrual migraine. As estrogen levels drop, a migraine attack can be triggered. It’s important to have a plan a few days before your period to prepare for worsening symptoms

Perimenopause is the hormonal phase leading up to menopause and can also trigger more attacks. The menstrual cycle becomes unpredictable as estrogen levels gradually decline. When menstruation finally ends, two out of three women report migraine improvement. This is due to estrogen levels reaching and staying at a consistent low level.

How a Hysterectomy Affects Migraine

Surgical menopause is another type of menopause that happens when surgery removes both ovaries. This removal causes a sudden drop in estrogen since it’s produced and released in the ovaries. Migraine attacks and symptoms can become more severe.

If you’re considering a hysterectomy, know what the surgery includes. Be ready with a migraine treatment plan.

A partial hysterectomy is a surgery to remove the upper part of the uterus, keeping your ovaries and female hormones intact. A total hysterectomy removes the entire uterus and cervix while leaving both ovaries in place. A radical hysterectomy, most often in response to cancer, can also include lymph nodes, the top of your vagina, uterus, ovaries and fallopian tubes.

When ovaries are removed, the procedure is called an oophorectomy. Bilateral oophorectomy is when both ovaries are removed, causing surgical menopause. If one ovary is left intact, a change in migraine is less likely than when surgery removes both.

One in three women with surgical menopause sees improvement in their migraine. Some have worsening symptoms, while some experience no change. The treatments discussed below can help you adjust to the quick shift in estrogen levels.

For transgender men, outcomes of a hysterectomy with both ovaries removed are like those of cisgender women. An oophorectomy will affect your hormone levels and reproductive options. Fortunately, research is ongoing. A clear discussion with your doctor is vital.

Managing Migraine After a Hysterectomy

Ask your doctor if your ovaries need to be removed to help you prepare for migraine changes after a hysterectomy. If so, follow up with a detailed discussion on managing migraine.

Hormone replacement therapy (HRT) replaces missing hormones using medication. Women with their uterus and ovaries removed usually take estrogen replacement therapy (ERT) right after surgery. A patch placed on your skin may be better than estrogen pills because a patch delivers a steady flow of estrogen. Shifting estrogen levels often trigger migraine attacks. Continuous delivery of estrogen is necessary for preventing symptoms.

Keep in mind that HRT isn’t recommended for all women. Your age, health history and type of replacement therapy can increase the risk of heart disease, stroke, blood clots and breast cancer. If you face these risks, talk with your doctor about starting a different medication well before surgery. If you’re already on medication to manage migraine, ask your doctor about increasing the dose or adding in other options.

Many medications are available for migraine relief and prevention, but be sure to talk to your doctor before changing your treatment plan. To name a few:

  • NSAID pain-relievers
  • Triptans
  • Amitriptyline
  • Venlafaxine
  • Blood pressure medications
  • OnabotulinumtoxinA (Botox®) (for chronic migraine)
  • Gabapentin (also for anti-seizure)
  • Topiramate (also for anti-seizure
  • CGRP blockers

Monoclonal antibodies against calcitonin gene-related peptide (CGRP) therapy may be helpful prevention options for episodic and chronic migraine—15 or more headache days per month with at least eight of them having migraine features. CGRP receptor antagonists can be helpful for acute relief and for prevention.

Some vitamins, minerals and herbs called nutraceuticals are helpful for people with migraine. Magnesium is especially good for women with menstrual migraine and those who experience migraine with aura. Other common supplements for migraine include vitamin B2, coenzyme Q10, melatonin and feverfew.

Lifestyle changes to manage triggers are also beneficial.

  • Keep a migraine diary to know your triggers and create strategies to manage them.
  • Manage blood sugar levels by eating three healthy meals daily with occasional snacks.
  • Practice ways to reduce stress.
  • Learn mindfulness and meditation.
  • Keep a regular sleep schedule. Avoid getting too much or too little sleep.
  • If you have dietary triggers, do your best to avoid them.
  • Experiment with physical exercises to know which ones improve or worsen migraine. Try alternative medicine or massages, such as acupuncture, talk therapy, pressure point massage and nerve stimulation devices.

A hysterectomy might include the removal of your ovaries, which can trigger intense migraine symptoms. To empower and prepare you before the surgery, know your options. Talk with your doctor to create the best plan for your individual needs.

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Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.

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