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Headaches and migraines

Headaches and migraines are something many women suffer with in the lead up to and after menopause. Here we explain why menopause can trigger migraines, and how they can impact your treatment options.

Some women are more prone to headaches and migraines than others. They’re also more common in women than in men - which indicates that our female hormones could have an influence. They are common around times of hormone change, such as when you first start your periods, in the perimenopause, and some women notice a pattern of headaches relating to their periods.

Firstly, what are migraines?

Migraines are a type of headache that range from moderate to severe. They usually cause pain or throbbing on one side of the head. Sometimes these headaches are also accompanied by other symptoms such as feeling sick, having increased sensitivity to light and/or sound.

There are 2 common type of migraine:

  1. Migraine with an aura - before the headache starts they’ll be warning signs like seeing flashing lights, or some form of visual change. Occasionally people get other symptoms such as pins and needles, or even weakness in arms or legs (hemiplegic migraine). The symptoms are fully reversible.If you get those symptoms it is essential that you are checked over by a doctor to make sure there is no other cause of them.
  2. Migraine without an aura - these are when there are no warning signs before the headache starts. This is the most common type of migraine.

If you suffer from migraines before, during or after menopause the type of migraine that you get does matter. Migraines with an aura impact the type of contraception and HRT that you should be taking. Women who have ever had hemiplegic migraine should never take the combined oral contraceptive pill.

Migraines at the start of menopause (perimenopause)

Migraines during perimenopause are common - and it’s likely that this is because of the large swings up and down of oestrogen and progesterone. These big swings in hormones have knock on effects in our brain (sometimes called the neurocrine response) that can cause headaches.

Other common symptoms like insomnia, and changes to mood can make headaches and migraines worse too.

Migraines without aura

It’s not all bad news though. Some women report an improvement to their migraines as they move through menopause. This is usually with women who suffer from migraines without an aura.

Migraines with an aura

For women who have migraines with an aura, the impact of menopause is less clear. For some women things improve, whilst for others they may get worse.

Migraines and HRT

Women who have auras with their migraines should not be taking hormones replacement therapy (HRT) as a tablet, as they’re at a slightly increased risk of having cardiovascular events such as a stroke. They may still be able to take HRT, it’s just important that it’s a transdermal (patch, gel) form.

For women who have migraines, but no visual changes with them, any form of HRT should be fine. Expect a consultation about HRT to include a question on migraines.

Women with a uterus who have to take a progesterone as part of HRT can sometimes find that taking this causes an increase in headaches or migraines. If this is happening to you, it may be worth considering getting the progesterone part of your HRT using a mirena coil. The mirena coil releases small amounts of synthetic progesterone (levonorgestrel) into the uterine system. It releases hormones at a steady level, which can help reduce symptoms for women who are sensitive to peaks and troughs in progesterone.

The dose and form of HRT taken may also impact migraines. Some studies have suggested that the likelihood of migraines is lower with transdermal (patch, gel) oestrogen than it is for tablet forms. It’s also important to be on the lowest dose which gives you relief from symptoms. A higher dose might cause more headaches. So taking the steps to track your symptoms, and optimise your oestrogen dose so there’s minimal side effects is a really important part of the process of adjusting to HRT.

Migraines and other menopause treatments

Although there is mixed evidence for acupuncture’s effects on menopausal symptoms, some women find it helps relieve both migraines, and other symptoms.

Another very important thing to remember during menopause is to stay hydrated. The sweats can leave you very dehydrated - which can lead to headaches. It’s important to maintain your hydration levels throughout the day, and take extra care if you’ve been experiencing hot flushes and night sweats.

References

  1. Hillard, T., Abernathy, K., Hamoda, H., Shaw, I., Everett, M., Ayres, J. and Currie, H., 2017. Management Of The Menopause. 6th ed. British Menopause Society.

  2. Nice.org.uk. n.d. Overview | Headaches In Over 12S: Diagnosis And Management | Guidance | NICE. [online]
    Available at: https://www.nice.org.uk/guidance/cg150 [Accessed 21 April 2020].