Perimenopause headaches and menopause migraine: why they happen and what helps
Updated 14 October 2026 · 8 min read · Based on NHS guidance and published research
Maybe you've always had the odd headache, and now they're coming more often. Maybe your migraines used to follow your periods, and now they don't follow any pattern at all. Or maybe you never got headaches, and suddenly you do.
Yes, perimenopause headaches are real. The NHS lists "headaches and migraines that are worse than usual" as a symptom of perimenopause and menopause. The Migraine Trust says it's common to have more frequent and more severe migraine attacks in perimenopause. Some women get migraine for the first time.
Most headaches aren't dangerous. But a few need help straight away, so please read this box first.
See a GP urgently or call 999 if:
Call 999 or go to A&E if you have a headache and:
- it started suddenly and is extremely painful (the worst headache you've ever had)
- you have numbness or weakness in your face, arm, leg or one side of your body
- you find it hard to speak, walk, balance or remember things
- you're drowsy or confused, or you've had a seizure (fit)
- you've lost some of your sight
- you have a very high temperature, a stiff neck, bright light hurts, or a rash that doesn't fade when you roll a glass over it
- you've had a head injury in the last 3 months
Don't drive yourself to A&E. Ask someone to take you, or call 999.
Get an urgent GP appointment or call 111 if you have a headache with vision problems, with vomiting, or with jaw pain when eating or a tender scalp. The same goes for a headache that gets worse when you cough, sneeze, bend down or exercise, a migraine attack lasting more than 72 hours, or aura lasting more than an hour.
See your GP soon if you have migraine with aura and you take the combined pill or HRT, or if aura starts or changes while you're taking them.
These come from the NHS pages on headaches and migraine, and from The Migraine Trust.
Can perimenopause cause headaches?
Yes. Hormone changes are a well-known headache trigger. The NHS headaches page lists "hormonal changes during your period or menopause" as a common cause.
Migraine is especially sensitive to hormones. The Migraine Trust says that:
- it's common to have more frequent and more severe attacks during perimenopause
- some women develop migraine for the first time during perimenopause
- after menopause, attacks often become less severe and less frequent, and may stop altogether
That last point comes with a catch. It can take a few years for hormones to settle, and migraine doesn't always improve. It's more likely to get worse if your menopause was caused by surgery, such as having your ovaries removed.
Why do hormones trigger headaches?
It's mostly about oestrogen, and in particular, oestrogen dropping. The Migraine Trust explains that a drop in oestrogen can make a migraine attack more likely. That's why many women get migraine just before a period.
In perimenopause, oestrogen doesn't fall smoothly. It rises and falls, sometimes sharply. The Migraine Trust says these "rapid changes" in hormone levels as you approach menopause can trigger attacks. Headache specialists say that women who already have migraine often find attacks get worse in both the early and late stages of the change.
Once hormones settle after menopause, the swings stop. That's why migraine often eases later on.
Is it a migraine or a tension headache?
Most headaches in midlife are one of these two types. Knowing which you get can help you and your GP.
| Migraine | Tension headache | |
|---|---|---|
| The pain | Often throbbing, often on one side | A dull ache on both sides, like a tight band |
| Other symptoms | Feeling or being sick, finding light and noise hard to bear | Usually none |
| Can you carry on? | Often hard to. Lying down in a dark room can help | Usually yes |
| How long | Usually 4 hours to 3 days | At least 30 minutes, sometimes several days |
This comes from the NHS pages on migraine and tension headaches.
Some people with migraine get an aura first. This is a warning sign such as zigzag lines or flashing lights, pins and needles, or trouble speaking. The NHS says aura should not last more than an hour.
Poor sleep, stress and other triggers
Hormones are rarely the only trigger. Perimenopause often brings others along with it.
Poor sleep. The Migraine Trust says hot flushes, night sweats and anxiety can disturb your sleep and add to stress, which can make a migraine attack more likely. The NHS lists sleep problems as a cause of tension headaches too. If night sweats are waking you, our article on night sweats may help.
Stress and anxiety. The NHS lists stress as a trigger for both migraine and tension headaches. Perimenopause can bring anxiety too. Our article on menopause anxiety explains why.
Other common triggers listed by the NHS include:
- skipping meals
- not drinking enough water
- alcohol
- too much caffeine
- straining your eyes, for example at a screen
- tiredness
Other causes to rule out
Not every headache in your 40s and 50s is about hormones. A few other things are worth checking.
- Taking painkillers too often. This can cause headaches of its own, sometimes called medication overuse headaches. The NHS suggests not taking migraine painkillers on more than 2 days a week.
- HRT. The NHS lists headaches as a possible side effect of both oestrogen and progestogen. Side effects often settle in a few weeks. If they don't, your GP can change the dose or type. Don't stop or change any medicine without talking to your GP first.
- Low iron. The NHS lists headaches as a common sign of iron deficiency anaemia. Heavy periods are a very common cause, and periods can get heavier in perimenopause.
- Eyesight problems. The NHS lists these as a cause of headaches. An eye test is a simple check.
What can help with perimenopause headaches
Things to try yourself
- Keep a headache diary. Note each headache, your periods, your sleep, and any flushes or night sweats. The Migraine Trust says this can show you a link, and it's useful to take to your GP.
- Keep a regular sleep routine. Go to bed and get up at about the same time. The NHS says sleeping more than usual can make headaches worse too.
- Eat at regular times. Don't skip meals, even if you don't feel hungry.
- Drink plenty of water, and cut down on caffeine and alcohol.
- Take painkillers early, but not too often. The NHS suggests taking them as soon as a migraine starts, and not on more than 2 days a week.
- During a migraine, lie down in a dark, quiet room if you can.
- Look after your stress levels. The NHS says stress can make headaches worse, and suggests trying to relax.
- Keep active. The NHS suggests regular exercise to help prevent migraine.
What your GP can offer
- Better treatment for attacks. If painkillers aren't helping, or you need them more often, your GP can suggest other medicines.
- Preventive medicine. If migraine has got worse around menopause, the Migraine Trust says your GP may suggest a medicine you take every day to make attacks less likely.
- HRT. The Migraine Trust says having migraine doesn't mean you can't take HRT. Some women find HRT helps their migraine, while others find it makes it worse. For women with migraine, doctors usually suggest patches, gel or spray rather than tablets, because these give steadier hormone levels.
- Other options. If you can't or don't want to take HRT, the Migraine Trust says some non-hormonal medicines, such as certain antidepressants and clonidine, can help with both migraine and menopause symptoms.
- A referral. If treatment from your GP isn't helping, ask about a headache clinic.
Migraine with aura, the pill and HRT
This part matters, so it's worth reading slowly.
The combined pill. The Migraine Trust says you should not take any combined hormonal contraception (such as the combined pill) if you have migraine with aura. This is because it can cause a small but real increase in the risk of stroke. If you get aura and you're on the combined pill, talk to your GP soon.
HRT is different. The Migraine Trust says migraine with aura doesn't rule out HRT, because HRT uses a lower dose and a different type of oestrogen. Doctors usually prefer patches, gel or spray.
If aura starts or changes on HRT, tell your GP. Headache specialists say HRT needs reviewing if aura comes back or gets worse. Speak to your GP promptly rather than changing anything yourself.
When to see a GP about headaches
The NHS says to see a GP if:
- your headaches or migraines are severe, getting worse, or lasting longer than usual
- you get them more than once a week, or regularly
- painkillers aren't helping
- you're finding migraine hard to control
- you regularly get migraine before or during your period
For anything urgent, use the box at the top of this page. Our symptoms checklist lets you tick off everything you've noticed and print a list for your GP.
Where relaxation fits in
Headaches and bad nights often go together. If you're also sleeping badly, you might like something gentle to listen to at bedtime. Menopause sleep hypnosis is our bedtime recording, Deep Sleep Through the Change. It's designed to help you relax and drift off. It's a relaxation recording, not a treatment, and it doesn't replace advice from your GP.
Related
Headaches often come with dizziness, tiredness and ringing in the ears (tinnitus), and you can see them all in our list of perimenopause symptoms.
This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.
