Menopause headaches: The link between hormones and migraines is real

It’s no secret that perimenopause, menopause and postmenopause come with a huge range of symptoms, some of which are debilitating. Research has shown that these symptoms are "sufficiently bothersome to drive almost 90 per cent of women to seek out their healthcare provider for advice on how to cope" [1].

When it comes to menopausal symptoms, you probably think of hot flashes, weight gain, sleeping issues, depression, anxiety, bloating and vaginal dryness. One of the lesser known, but extremely common, symptoms is headaches. 

If you're dealing with menopause-related headaches, we're here to help. Here's everything you need to know about this irritating symptom and how best to treat them.

Is a headache a sign of menopause?

With the variety of symptoms that can begin during perimenopause, it’s difficult to say whether one is a definite sign of menopause. However, headaches and migraines are fairly common for those going through perimenopause due to the fluctuation of hormones.

Perimenopause can also cause irregular periods and many women can find that they experience headaches more often during their menstrual cycle.

In fact, a study from 1993 found that 85 per cent of women who experienced headaches did so before they reached menopause, which indicates that those in the perimenopause stage seem to suffer most from headaches [2]. These are often referred to as hormonal headaches. 

Due to the prevalence of headaches in perimenopause, many women tend to experience fewer headaches once they've reached menopause, which is 12 consecutive months after your last period — although, this isn't guaranteed.

The problem with attaching headaches to a specific cause is because of how much it can vary from person to person. What is a trigger for one person, might be a cure for another (for example, caffeine can help headaches for some but be a big trigger for others). Due to this, headaches aren’t always a sign of menopause. 

The best way to determine whether your headaches are a sign of perimenopause is by tracking your symptoms. This will allow you to determine any potential triggers, the times they are most likely to occur and the severity of them. This is all information that’s really helpful for your GP when it comes to treating your symptoms.

What's the connection between headaches and menopause?

As previously mentioned, headaches aren’t the most common symptom of menopause or perimenopause — typically hot flashes and irregular periods are the most common — but they certainly affect many women. 

Evidence from various studies suggests that menopause headaches are caused by changes in hormone levels [3]. During the menopause transition (or perimenopause), oestrogen and progesterone decline dramatically as the body produces less of the hormone. Testosterone gradually decreases during this time, too. 

Despite the connection between changing hormone levels and headaches has been cited for decades, there is actually a lack of significant research into how many women experience hormone-related headaches.

What does a menopause headache feel like?

Menopause-related headache pain is generally described as a dull ache on both sides of your head. It's common for people to describe the pain as a rubber pain tightness and tension across the head.

Generally speaking, a menopausal headache should subside with painkillers and you should be able to continue with your day-to-day activities for the most part.

Migraine headaches, on the other hand, are more severe and you likely won’t be able to continue with your planned activities for the day. A migraine brings intense pain, typically on one side of the head, and it can be accompanied by nausea, vomiting and sensitivity to light and noise.

How long do menopause headaches generally last?

It’s difficult to say how long menopause headaches last because there are so many variables. Headaches typically last between 30 minutes and a few hours, whereas migraines can last between a few hours and three days. 

A 2015 study found that 50 per cent of its participants had menopausal headaches that lasted longer than a day [3]. If you're suffering from a menopause-related headache, it's important to drink lots of water to stay hydrated, rest as much as possible and take painkillers to relieve the pain.

If you find that the headache frequency is increasing, or you're experiencing more severe headaches, it's best to contact your GP, who will be able to provide you with personalised advice and treatment.

How to treat menopause headaches?

Due to a lack of research, it’s difficult to conclude how best to treat menopause-related headaches. One study suggests that postmenopausal hormone replacement therapy was associated with migraines worsening but for some, HRT can improve headaches [3].

Typically, treating all menopause symptoms, including headaches, comes down to a multifaceted approach. 

Practice good sleep hygiene

While sleep can be difficult when experiencing menopause symptoms, it does play an important role in headaches.

A 2011 study found a connection between a lack of REM sleep and headaches, with researchers discovering that too little sleep can actually increase the proteins in the body that are associated with chronic pain and in turn, cause painful headaches [4].

These include:

• Sticking to a regular sleep schedule (even on the weekend)
• Limiting screen time an hour before bed
• Following a wind-down bedtime routine (this might include a shower or bath, a skincare routine and reading).

While sleep might not always be easy to come by, creating healthy habits around sleep can be helpful. And, in turn, can help reduce the severity and regularity of headaches.

Find your food triggers

Interestingly, some foods can play a role in triggering headaches. And, while eating a balanced diet is important for your overall health and well-being, there might be some foods that just don't work for your body.

Research has found a variety of foods and drinks that can be headache-triggering for some people [5]. These include:

• Chocolate (containing phenylethylamine)
• Alcoholic drinks (especially red wine)
• Artificial sweeteners (aspartame)
• Greasy foods
• Pizza, hamburger and pork dried with nitrate preservatives
• Salted fish
• Yeast
• Foods containing monosodium glutamate (potato chips, cornflakes and dry roasted peanuts

Working out what foods may impact your headaches can help you prevent further migraines in the future.

Engage in regular exercise

While exercise can be a potential trigger for headaches and migraines in some people, research shows that it can also be incredibly helpful in preventing headaches from occurring [6].

Rigorous aerobic exercise can provide a significant reduction in migraine frequency, intensity and duration, while low-impact exercise like yoga can also be helpful in treating tension headaches and related neck pain.

Try to incorporate movement into your daily routine and see how it impacts your headaches.

Reduce stress where possible

Stress is hard to avoid in most areas of life, but learning how to manage it is important — especially if you're a headache sufferer. Stress can be a major cause of tension headaches, so if you're regularly experiencing these, it may be helpful to look at ways to manage your stress differently.

This might include engaging in gentle exercise, taking up meditative hobbies like painting or drawing or incorporating calming breathing exercises into your everyday life.

What makes migraines different?

While the terms headaches and migraines are often used interchangeably, the two are quite different.

Headaches typically include the following symptoms:

• Tightness and pressure that may feel like a tight band around your head 
• Dull and persistent 
• Tender feeling 
• You can typically carry on with day-to-day activities once the headache has subsided or after taking painkillers [7].

The symptoms of migraines, on the other hand, are usually more acute and include:

• Severe headaches that involve throbbing pain or pulsating
• Sensitivity to light 
• Nausea and even vomiting 
• Sensitivity to sound 
• An aura — this is described as seeing flashing lights or a change in vision 
• Migraines often make people bed-bound for hours or even days and disrupt day-to-day activities [8].

Menopause hot flashes and headaches

Hot flashes and headaches occur together for a lot of women [3]. Hot flashes (also known as hot flushes) are sudden feelings of intense heat that spreads across your face, neck and chest and often lead to sweating. These flushes can last for a matter of seconds or up to 10 minutes.

The most effective way to treat symptoms like hot flashes and in turn, headaches, is Menopausal Hormone Therapy, or MHT, previously referred to as Hormone Replacement Therapy (HRT) [8].

By improving menopausal symptoms like hot flushes and night sweats with MHT, it can also help to reduce the frequency and severity of headaches and migraines, as these symptoms generally occur together.

Risks of headaches

Once you reach menopause, the risk of certain health issues can also increase. The postmenopausal stage in life can increase your risk of cardiovascular disease (conditions affecting the heart and blood vessels) and osteoporosis (a condition that weakens the bones) [9].

Sometimes, headaches can be a cause for concern, whether they’re related to menopause or not. 

You should seek medical assistance for your headache if: 

• It’s unbearable and worse than you’ve ever had it before 
• You have a fever 
• You’re dizzy
• You’re confused 
• You develop a rash.