Learn about the effect perimenopause can have on migraine and the treatment options available to help.

In honor of Menopause Awareness Month, we’re opening the discussion on menstruation, perimenopause and menopause—and how they affect those who live with migraine. Menopause is the natural end of menstrual cycles, occurring for most women between the ages of 45-55. Hormonal changes come with menopause, and hormonal fluctuations often play a big role in migraine attack frequency and severity. If you have migraine and are someone who menstruates, hormonal changes—particularly a drop in estrogen levels—may trigger attacks for you. The hormonal changes that come before, during, and after menopause may affect symptoms, the frequency and severity of attacks and more. Read on and learn what you can do to prepare yourself and how to get preventative treatment.

Perimenopause and Its Effect on Migraine

Perimenopause refers to as the menopause transition, or the months or years leading to menopause. During this time, hormonal fluctuations may trigger more migraine symptoms and attacks. Some women may even experience worse pain from migraine. As you approach the age range of menopause and experience perimenopause, speak with your doctor about how it will affect your migraine. Work closely together to come up with a plan for potentially worse migraine attacks.

If you experience some or all of the below symptoms, pay attention to how they affect your migraine symptoms. Be sure to record them in a symptom diary and inform your doctor.

  • Hot flashes
  • Vaginal dryness
  • Insomnia
  • Weight gain
  • Reduced libido
  • Difficulty concentrating
  • Memory problems
  • Depression
  • Anxiety
  • Increased urination

When menopause occurs, many women find their migraine attacks decrease or completely stop. This is because menopause creates stable hormone levels. Without the fluctuation of hormones, the severity and frequency of attacks can decrease.

Menstrual Migraine Treatments for Perimenopause

Treatments for menstrual migraine may help with migraine symptoms during perimenopause. Here are three treatment strategies that you can consider to manage migraine during your menstrual cycle or during perimenopause. And as always, be sure to talk to your doctor before altering your treatment plan.

Acute Treatment

  • Oral tablets

Fast-acting triptans, such as sumatriptan, rizatriptan and zolmitriptan, taken with a non-steroidal anti-inflammatory drug (NSAID), like naproxen and ibuprofen, can help with managing migraine. CGRP blockers, including Nrtec and ubrelvy, and nontriptans like Reyvow, can also be taken as oral tablets.

  • Injectables

These provide quicker relief than oral tablets. Sumatriptan is the only injectable triptan that comes in needle and needle-free auto-injecting syringes. It starts having an effect within 10 minutes of entering the bloodstream. There is also Dihydroergotamine (DHE), though they do not come in auto-injecting syringes. Combining either one with an NSAID can create an even greater benefit.

  • Nasal sprays

While they do not act as quickly as an injection, a sumatriptan nasal spray is faster than an oral tablet. They may also be more comfortable or convenient to take. DHE is also available as a nasal spray, both as a standard nasal sprayer and a novel spray apparatus (trudhesa).

Mini-preventative Treatment

  • NSAIDs

Taking a long-acting NSAID, like naproxen, twice a day during the five to seven days at the start of your period may decrease or prevent a migraine attack from happening.

  • Hormones

Using an estrogen supplementation can help prevent the drop of estrogen that often triggers a migraine attack. A supplementation can come in the form of a pill, vaginal gel or patch. Please note that there are differing opinions on whether or not estrogen is safe for those with migraine with aura, especially around the menopause age range. Please consult your doctor if estrogen would be a suitable treatment plan for you if you have migraine with aura.

  • Triptans

Many studies have shown that triptans are effective in migraine treatment. Some triptans, like zolmitriptan, are also available as nasal sprays. Dosing twice a day throughout your period may decrease or prevent menstrual migraine. However, be sure to discuss proper dosing with your doctor to avoid medication overuse headache.

  • Magnesium

Taking magnesium 15 days after the start of your period and continuing to take it until the start of the next period can help manage menstrual migraine. An additional benefit of magnesium is that it does not need to go by regular cycles. This means that it is a versatile and safe method for women who don’t have regular cycles.

If you have menstrual migraine, talk to your doctor about how perimenopause and menopause can affect your migraine. Menstrual migraine can feel isolating, but remember that there are many treatment options out there. Whether you’re still menstruating, going through perimenopause or in menopause, migraine can still be treated and managed.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.