Benign headache disorders such as migraine are more common in women. Roughly 80% of patients seeking care at the John R. Graham Headache Center are women. Not only are women more likely than men to have migraine in the first place, but they have on average more frequent and severe headaches than do men with the disorder.
The relationship between headaches and hormones is complex and not fully understood. Good quality evidence supports the view that declining estrogen levels can trigger migraine attacks in many women who are susceptible to the disorder. Estrogen levels decline gradually before a naturally occurring menstrual cycle. In women taking combination oral contraceptives (pills that contain both estrogen and a progestin) estrogen levels fall during the week when placebo (sugar pills) are used. This does not occur in women who are using continuous forms of oral contraception, where active pills are given for a prolonged period of time. Estrogen levels also fall immediately after childbirth, making this another time when headaches may be more likely to occur in women already prone to migraine.
What to expect around menopause
The peri-menopausal transition is the 2-5 year span of time before menopause when a woman’s menstrual periods are less regular. Some women experience estrogen withdrawal symptoms such as hot flashes or vaginal dryness. During this time hormone levels may fluctuate erratically. Women with hormonally influenced headaches may find their headaches are less predictable during this transition, and some may need additional preventive treatment for headache.
What to expect after menopause
Both men and women with migraine often find that headaches improve as they get older. To some extent, that is a function of age. However, some women who found that they were very sensitive to changes in their hormone levels, and who used to have headaches when they experienced their menstrual period or right before, the headaches tend to get better with menopause. Unfortunately, a small subset of women find that migraines are worse during menopause.
In those cases where headaches are worse during menopause, standard headache treatments are prescribed. There is no evidence that estrogen or hormone replacement therapy is helpful for post-menopausal migraines, and we do not recommend them for this purpose. These treatments are sometimes used to prevent bone loss or for severe hot flashes, but in general are avoided because of new evidence about possible risks of cancer and heart disease.