15% of the UK population are affected by migraine. From puberty onwards, women are 3x as likely to be affected by migraine than men. Migraine is one of the recognised symptoms of menopause and women may start having migraine attacks for the first time or they might notice their pre-existing migraine episodes become more severe or frequent during perimenopause and menopause. Migraine episodes are common in perimenopause particularly when hormones are fluctuating more, and they tend to slowly ease off in the postmenopausal years.
What is a migraine?
A migraine is not the same as a bad headache. Migraine is a whole-body condition of which headache is usually, but not always, a symptom. A migraine headache is commonly a severe pain, usually on one side of the head that often comes with sensitivity to light and sound and/or nausea or vomiting.
Some people notice changes a few days before a migraine occurs. These may include:
- feeling very tired and yawning a lot
- craving certain foods or feeling thirsty
- changes in mood
- having a stiff neck
- needing to wee more.
Migraine attacks present in different ways and are divided into different types, the most common of which are:
- Migraine with aura – when there are temporary disturbances for up to an hour before the head pain starts, such as seeing flashing lights, zig zag lines, blurred spots or in rarer cases feeling dizzy, numb, having ringing in the ears, slurred speech or confusion.
- Migraine without aura – this is the more common type of migraine where throbbing head pain comes on without any warning signs. The pain often occurs alongside sensitivity to light and nausea.
- Aura without any headache – sometimes referred to as a silent migraine, this type has some aura symptoms, but the migraine head pain does not develop.
Migraine episodes can last for a few hours or up to 3 days. They may occur more than once a week, happen every month or so, or can be years apart.
What causes migraine?
Migraine often runs in families (but not always), and it’s thought that a particular combination of genes makes you more susceptible to migraine triggers such as stress and hormone changes, as well as environmental and lifestyle factors that can bring on a migraine.
Some common triggers for migraine are:
- changes in routine such as at weekends, travelling and during a holiday, and changes to sleeping patterns or mealtimes
- stress
- too much or too little sleep
- caffeine and alcohol
- environment (temperature changes, humidity, glaring lights, loud noises)
- smells from perfume, smoke, paint, bleach etc.
- using a computer
- missing meals
- dehydration
- vigorous exercise if you’re not used it.
The impact of migraine attacks can be wide ranging. It is common for sufferers to have to take time off work and stay in bed during an attack. Research by the Migraine Trust found that 60% of people living with migraine felt it had significantly impacted their relationship with their partner, and 70% reported their mental health had been significantly affected by their migraines.
Migraine, menopause and HRT
In women, migraine attacks can be triggered when estrogen levels are low, higher than usual, or changing.
Most often, low estrogen can trigger migraine (usually without aura). Low estrogen occurs just before a period so it’s common for women to experience an attack at this time of the month and also around the time of menopause when estrogen levels have declined.
You may get migraine with aura when estrogen is high, such as when pregnant, when taking the contraceptive pill or when taking HRT for the first few months as your body is getting used to the hormones.
If you are in perimenopause, the shifting nature of estrogen might be what is causing migraine if you have a greater sensitivity to your own hormonal changes. This might coincide with changes to your periods and migraine episodes may be linked with other symptoms of perimenopause such as hot flashes, night sweats, poor sleep and mood swings.
For most women that experience migraine in perimenopause and menopause, taking the right type and dose of HRT improves the amount, severity and frequency of attacks.
Estrogen via a skin patch is often recommended for women who have migraine as this releases a steady dose throughout the day and helps keep estrogen levels more stable. It helps to not have any breaks in treatment and to start with a low dose that is increased gradually if needed, to further help with symptoms. For those with a uterus, the type of progesterone used in your HRT is also important to try and optimise control of migraine. In addition, some women find adding testosterone to their HRT regime beneficial for their migraines too.
Not all migraine episodes however are caused by hormone changes, so you may continue to suffer with migraine even though you are taking the right dose and type of HRT.
Other ways to help migraine
- Keep a diary of your migraine attacks. Note the date, what day of the week it was, how long it lasted for, how severe it was (you could use a 1-10 rating), what other symptoms you had with it, any known triggers, and what helped the migraine ease off.
- Once you have identified your triggers from your record keeping, try and avoid them as best you can. This is easier said than done, especially if there’s more than one trigger. And it can be hard to change routines, especially if other people are involved too. It takes time, effort and support to make major changes to routines so be realistic about what impact any changes will have on you and those you live with.
- A healthy lifestyle with consistent routines of regular exercise, good sleep and eating nutritious meals regularly will help your ability to cope with migraines when they strike.
- Over the counter painkillers such as paracetamol and ibuprofen may help ease some of the head pain.
- You may not be able to eliminate your migraines completely. If you’re still struggling with migraine after you’ve addressed potential triggers and usual pain relief is not enough, see your doctor and maybe a specialist to talk about the option of using additional medication.
For further information on migraine, we recommend reading ‘Managing your Migraine’ by Dr Katy Munro and visiting The Migraine Trust website.
Last updated: June 2026
