This article discusses menopause and headaches. It also explains how shifting hormones cause different types of headaches related to menopause. This article also provides ways to find relief from hormonal headaches and possibly even prevent headaches and migraines during menopause.

Symptoms of Menopausal Headaches

Headaches associated with menopause are known as hormonal headaches. Migraines and tension headaches are the most common types of hormone-related headaches.

A tension headache can feel like:

A persistent “rubber-band around the head” sensationOften start at the forehead and radiate around to the back of the headA dull tightening or pressure on both sides of the headMuscle tension in the neck and shouldersThe discomfort lasts a few hours to a few days

Migraines can feel like:

A gradual progression of head pain to a moderate or severe throbbing headacheThe pain is often constantMay include nauseaActivity, light, or loud noises can make it worseCommonly last for a few days and can be followed by exhaustion or brain fog

Hormonal headaches typically occur up to two days before your period and can last up to three days after your period starts.

Causes of Menopausal Headaches

Hormones cause menopausal headaches. A drop in levels of estrogen—the primary sex hormone in cisgender females—is to blame. Commonly known as menstrual migraines, they strike a day or two before your period starts. 

Women are three times more likely to experience a migraine than men. 12% of menopausal women have high-frequency headaches (10 or more per month). For 24. 4% of menopausal women, their headaches improved with menopause. For 35. 7% of menopausal women, their headaches worsened with menopause.   Women who experience early menopause are at a higher risk of migraines. Migraines may wake you up at night or early morning hours.

In the years leading up to menopause, your menstrual cycle changes. Periods come more frequently, causing an uptick in hormonal headaches. Hot flashes and night sweats—two common menopause symptoms—can also trigger migraines during perimenopause and menopause.

Many women find monthly hormonal migraines and headaches resolve after menopause. However, some women experience an increase in hormonal headaches as estrogen levels plummet even further. Many women experience more frequent tension headaches in the post-menopausal years.

What Menopause Medications Can Cause Headaches?

Medications used to treat menopause symptoms can sometimes contribute to headaches. This includes hormone replacement therapy (HRT), such as estradiol and progesterone.

While often helpful in relieving hot flashes and other uncomfortable symptoms of menopause, HRT can trigger headaches in some women. If you suspect HRT is causing headaches, talk to your healthcare provider about adjusting the dose.

Herbal remedies used to balance hormones and relieve menopause symptoms may also cause headaches. These include:

Black cohoshEvening primrose oilGingko bilobaGinsengRed cloverSt. John’s wort

How to Treat Menopausal Headaches

A two-pronged approach of prevention and treatment is recommended for menopausal headache relief. Over-the-counter and prescription medications help relieve the symptoms. Lifestyle changes, hormone therapy, and prophylactic (preventive) medications can help to reduce headache frequency.

Treating Menopausal Migraines

Some migraines respond well to over-the-counter medications. According to research, combination of 500 mg acetaminophen, 500 mg aspirin, and 130 mg caffeine—or two Excedrine tablets—is often highly effective. You may need to to take two tables every six hours until the migraine resolves (typically three days).

For migraine associated nausea, Benadryl (diphenhydramine), Dramamine (dimenhydrinate), or Bonine (meclizine) can help. However, these OTC medicine can make you drowsy, so use caution.

Prescription medications used to treat migraine pain and other symptoms include:

Triptans like Imitrex (sumatriptan), Relpax (eletriptan), and Zomig (zolmitriptan)Butalbital, a barbiturate, in combination with acetaminophen (Fioricet) or aspirin (Fiorinal) and caffeine) Ergots such as dihydroergotamine and Cafergot (ergotamine)Oral steroids like prednisone and dexamethasone for migraines that last more than three daysAnti-nausea medicine such as Reglan (metoclopramide) or Zofran (ondaseteron)

Non-drug treatments for migraine include lying down in a dark and quiet area. A cool rag on your forehead, the back of your neck, and over your eyes can help decrease swelling, block out light, and reduce nausea.

Treating Menopausal Tension Headaches

Tension headaches are often treated with OTC headache medicines. These include:

Tylenol (acetaminophen)Advil or Motrin (ibuprofen)Aleve (naproxen)Ecotrin, Bufferin, or Ascriptin (aspirinExcedrin (acetaminophen, aspirin, caffeine)

Non-drug treatments for tension headaches include drinking more water, getting enough sleep, relieving stress levels, neck and shoulder massage, ice packs, and physical therapy to relieve muscle tension.

How to Prevent Menopausal Headaches

Recurring headaches during menopause are often treated with prophylactic (preventive) medications, HRT, and lifestyle changes. A doctor can prescribe preventive medications for headaches that occur twice a week or more.

Hormone Replacement Therapy

The most commonly prescribed treatment for menopause symptoms is HRT. HRT—an umbrella term for medications that replace low estrogen and progesterone levels—has mixed results as a treatment for menopausal headaches. If used for headache prevention, steady, continuous doses of hormones are recommended.

HRT comes in several different formulations with various concentrations of hormones. In addition to pills, hormones are delivered through the skin in transdermal patches, topical creams and sprays, or intra-vaginally with rings, suppositories, and creams.

Common HRT medications include: 

Oral (pills):  Bijuva (estradiol and progesterone), Activella (estradiol and norethindrone), FemHRT (Ethinyl estradiol and norethindrone), Jintei (Ethinyl estradiol and norethindrone), and Prempro (conjugated estrogens and medroxyprogesterone)Transdermal patch: Alora, Climara, Estraderm, and Vivelle-Dot (all estradiol transdermal systems)Topical cream: Estrogel (estradiol gel)Topical spray: Evamist (estradiol transdermal spray)Vaginal ring: Estring (estradiol vaginal ring)Vaginal suppository: Imvexxy (estradiol vaginal suppository)Vaginal creams: Premarin vaginal cream (conjugated estrogens)

HRT—in particular progesterone replacement—can also contribute to hormonal headaches. Talk to your healthcare provider if you are still experiencing hormonal headaches on HRT. They may be able to prescribe a different formula.

Non-Hormonal Medicine

Depending on your symptoms, your healthcare provider may prescribe non-hormonal medicines to prevent and treat recurring migraines. These include antidepressants and anticonvulsants.

Antidepressants used to prevent migraines include:

Effexor (venlafaxine)Paxil (paroxetine)Lexapro (escitalopram)

Elavil (amitriptyline) is used to prevent chronic tension headaches. Gralise (gabapentin), an anticonvulsant (anti-seizure medication), is effective in preventing menopausal migraines and tension headaches. 

Lifestyle Changes

Lifestyle techniques to help prevent migraines and tension headaches caused by menopause include:

Maintain a healthy lifestyle: Adopting healthy lifestyle changes such as eating well, exercising, stress management, and getting enough sleep can help prevent headaches. Hydrate (drink water): Decreased hormone levels make it more difficult for your body to replenish fluids. This can cause dehydration, which can lead to headaches. Drinking water helps your body replace the fluid it loses. Avoid triggers: It can be helpful to identify and avoid food or environmental triggers such as alcohol, dairy, gluten, monosodium glutamate (MSG), strong smells, or bright lights. Alternative therapies: Some people use natural supplements such as B vitamins, coenzyme Q10, magnesium, black cohosh, and butterbur to prevent migraines. Acupuncture, massage, and essential oils are also alternative methods that may help. Talk with your healthcare provider to see which are an option for you.

Are There Tests to Diagnose the Cause of Menopausal Headaches?

Blood tests that measure hormone levels are sometimes used to diagnose menopause and related symptoms, including menopausal headaches. These include:

Follicle-stimulating hormone (FSH) Luteinizing hormone

However, healthcare providers often diagnose menopause based on a woman’s age and the presence of other menopause symptoms. Hormone level testing is more common when early menopause is suspected in women in their 30s.

Your healthcare provider may run additional labs and imaging studies to rule out other potential causes for headaches. These can include blood and urine tests, an electroencephalogram (EEG), computed tomography (CT) scan, or magnetic resonance imaging (MRI).

When to See a Healthcare Provider

For women in their 40s or 50s, menopause is one of many potential causes of headaches. If you experience frequent headaches or migraines, talk with your healthcare provider.

You should also seek medical care for any of the following symptoms:

A sudden, severe headache A headache that wakes you A headache that occurs with a high fever or rashA headache combined with dizziness or weakness Headaches combined with unexplained weight lossHeadaches that are getting worse or feel different than beforeHeadaches that occur frequently and aren’t relieved with OTC medication

Summary

Hormonal headaches like migraine and tension headaches can become more frequent during perimenopause. Menopause sometimes relieves menstrual migraines but may trigger tension headaches.

Medications and lifestyle changes can help to relieve menopausal headaches. While at-home remedies can help, it’s best to see your healthcare provider for frequent or severe headaches. 

Prescription medications can treat and prevent hormonal headaches. HRT, pain relievers, antidepressants, and anticonvulsants can help ease symptoms and reduce headache frequency.

A Word From Verywell

Recurring headaches can hinder your quality of life. For women in their 40s and 50s, frequent headaches may be caused by hormone fluctuations from menopause and perimenopause. Menopause symptoms vary for every woman and can change as you move through the transition. Talk to your healthcare provider if menopause symptoms affect your activities of daily living. They may want to rule out other underlying conditions or prescribe medications. 

Changes in periodsHot flashesNight sweatsVaginal drynessDry skin ForgetfulnessMood swingsLow sex driveTrouble sleeping Urinary incontinence (leakage)