What do headaches feel like during menopause?

The NHS lists headaches and migraines that are “worse than usual” among menopause symptoms (NHS, Menopause: symptoms). Some women notice their headaches becoming more frequent; others notice that the migraines they have had for years are changing.

It helps to tell two types apart:

  • Ordinary headache: Usually not dangerous, and goes away within a few days. It can come from everyday causes such as stress, skipping meals, not drinking enough fluids, too much alcohol, poor posture and eyesight problems. The NHS also lists hormone changes linked to periods and menopause among common causes of headaches (NHS, Headaches).
  • Migraine: Usually a throbbing pain on one side of the head that gets worse with movement. It can come with nausea, vomiting and sensitivity to light and sound. Some people get warning signs called aura before the pain: flashes of light, zigzag lines or tingling, for example. Aura should not last longer than 1 hour (NHS, Migraine).

Why do migraines increase in perimenopause?

Migraine is more common in women than in men and is closely tied to hormones. Attacks that come just before or during a period are called menstrual migraine; these attacks are often longer and more severe (NHS, Migraine).

Perimenopause, the transition to menopause, is a time when hormone levels change not steadily but with ups and downs. According to The Migraine Trust, it is common for migraine attacks to be more frequent and more severe in perimenopause. The main reason is the rapid fluctuation in hormones, especially estrogen (The Migraine Trust, Migraine and menopause). The American Migraine Foundation also says hormone fluctuations in perimenopause can lead to more attacks and, for some women, more severe pain (American Migraine Foundation, Migraine and Menopause).

Other perimenopause symptoms can affect headaches indirectly. Night sweats and insomnia disrupt your sleep pattern; tiredness and stress are also known triggers (NHS, Migraine). The American Migraine Foundation suggests tracking symptoms such as hot flashes and insomnia alongside migraine (American Migraine Foundation, Migraine and Menopause). If you have sleep problems, menopause insomnia may help.

What happens to headaches and migraine after menopause?

There is good news here. According to the NHS, migraine in women often eases after menopause (NHS, Migraine). The Migraine Trust also says it is common for attacks to become less frequent and milder after menopause, although it can take a few years for hormones to settle fully (The Migraine Trust, Migraine and menopause). According to the American Migraine Foundation, for many women attacks decrease or stop completely as hormone levels stabilize (American Migraine Foundation, Migraine and Menopause). So the worsening you experience in perimenopause does not have to be permanent; getting through this time by keeping a record and talking to your clinician makes it easier.

But this does not apply to everyone. In menopause brought on by surgical removal of the uterus or ovaries (surgical menopause), migraine is more likely to continue or get worse. The Migraine Trust advises talking to your clinician about the possible effects on your migraine before such an operation (The Migraine Trust, Migraine and menopause).

Which headaches are an emergency?

Most headaches are not dangerous. But some symptoms need urgent assessment. The NHS lists these situations as follows (NHS, Headaches; NHS, Migraine):

Call your local emergency number (112 in Türkiye and the EU, 911 in the US) right away or go to the emergency department if:

  • The headache started suddenly and is extremely severe.
  • You have hit your head in the last 3 months.
  • You have a seizure, numbness or weakness in your face or body, or problems with speech, balance, walking or memory.
  • You have drowsiness, confusion or loss of vision.
  • You have a rash that does not fade when you press a glass against it.
  • You have a very high temperature, a stiff neck or sensitivity to bright light.

Do not drive yourself to the emergency department (NHS, Headaches).

Contact your clinician the same day if:

  • You have vision or eye problems along with the headache.
  • The pain starts or gets worse when you cough, sneeze, bend over or exercise.
  • You are vomiting along with the headache.
  • You have jaw pain when eating or tenderness of the scalp.
  • A migraine attack lasts longer than 72 hours, or aura lasts longer than 1 hour.

(NHS, Headaches; NHS, Migraine)

If you have any of these symptoms, do not put it down to menopause and wait.

What else can cause headaches?

Among common causes of headaches, the NHS lists colds and flu, stress, too much alcohol, poor posture, eyesight problems, skipping meals, not drinking enough fluids, taking too many painkillers, and hormone changes linked to periods or menopause (NHS, Headaches).

Painkiller use matters in particular. The NHS recommends using painkillers on no more than 2 days a week; using them more often can make headaches worse and make migraine harder to control (NHS, Migraine). The Migraine Trust calls this medication overuse headache (The Migraine Trust, Migraine and menopause).

Why does a headache diary help?

The NHS says keeping a headache diary can help you understand what triggers your headaches (NHS, Headaches). The Migraine Trust also says a diary can show the link between migraine, your menstrual cycle and menopause symptoms, and suggests taking this record to your GP (family doctor) (The Migraine Trust, Migraine and menopause).

Things you can write in your diary:

  • The date, start time and length of the pain
  • How severe it is (for example on a 0–10 scale)
  • Where the pain is and what it feels like: throbbing or pressing?
  • Whether there was aura, nausea, or sensitivity to light or sound
  • Your cycle day or the date of your last period
  • How you slept that night, and whether you had hot flashes or night sweats
  • Skipped meals, caffeine and alcohol
  • Any painkiller you took and how many days you used it

If your periods are changing too, irregular periods at 45 can help you understand this time.

When should you see a doctor about headaches, and what should you ask?

See your GP if your own measures are not working, if your headaches keep getting worse, or if you get headaches regularly (NHS, Headaches). If you find you need painkillers more and more often, mention that too; if your GP’s treatment is not enough, you can ask to be referred to a headache clinic or a neurologist (The Migraine Trust, Migraine and menopause).

Questions you could ask:

  • Are my headaches migraine, or another type?
  • Could they be linked to the hormone changes of perimenopause?
  • If I have aura, how does that affect the options we discuss later?
  • Is my painkiller use within a safe limit?
  • Do I need to be referred to a neurologist?

This page does not describe treatment options. Talk to your clinician about the options for headaches and menopause symptoms.