Chapter 7, Episode 4: Migraine During Perimenopause and Menopause
TRANSCRIPT
This content has been medically reviewed by Dr. Carolyn Bernstein, MD, FAHS.
Migraine often changes throughout a person’s lifetime, and the years surrounding menopause may bring significant changes in attack frequency, severity, and symptoms. Hormones can play a key role in migraine, so when hormone levels begin to fluctuate in perimenopause, migraine attacks can change as well.
Perimenopause is the transition leading up to menopause. It typically begins between ages 40 and 55 and lasts an average of 4 years, although it can be shorter or longer.1 During this time, fluctuating estrogen and progesterone levels can make migraine attacks more frequent or more severe, even if migraine had previously been well controlled. Some people may even experience their first migraine attack during perimenopause.
Menopause occurs when a person has gone 12 consecutive months without a menstrual period, followed by postmenopause. For most people, menopause happens spontaneously. Others experience surgical menopause when their ovaries are removed for medical reasons. Unlike the gradual hormonal changes of natural menopause, surgical menopause causes a sudden drop in estrogen, which may result in more abrupt changes in migraine patterns.
Acute treatment options during perimenopause or menopause are generally the same as treating migraine in adults. Acute treatments can help abort or lessen the symptoms of migraine attacks when they occur. These include: NSAIDs, acetaminophen, combination analgesics, triptans, gepants, ergot alkaloids, neuromodulation devices, and anti-nausea medications.
Some preventive treatments may also help relieve symptoms of perimenopause while reducing the frequency of migraine attacks. For example, venlafaxine can help with mood and hot flashes, and amitriptyline or nortriptyline can help with sleep disruption.2,3
Other migraine preventive options include vitamins and supplements, anti-seizure medications, CGRP monoclonal antibodies, gepants, onabotulinumtoxinA, neuromodulation devices, and behavioral therapies.
Some people use hormonal therapies to lessen symptoms of perimenopause and menopause, such as insomnia, which may in turn help with migraine. Individual risk factors for hormonal therapies should be reviewed with a healthcare provider, especially for people who experience aura with their migraine attacks. It is important to consult your healthcare provider if you develop new-onset migraine with aura or an increase in frequency or worsening of migraine with aura.1
Tracking your attacks in a migraine diary can help you and your clinician identify patterns, evaluate how treatments are working, and make informed decisions about whether to adjust your treatment plan.
If you are preparing for a medical procedure that will result in menopause, talk with your healthcare team in advance about how to manage migraine as your hormone levels change.
Living with migraine during perimenopause and menopause can be challenging, and everyone’s experience is different. Many people find that migraine improves after menopause, while others see little change or may experience worsening symptoms.1 Work with your healthcare provider to track your symptoms, adjust your treatment plan when needed, and find the approach that works best for you.
For more information, visit migrainedisorders.org.
References
*The contents of this video are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.