Common Stressors

Pregnancy, perimenopause and menopause

How migraine often changes with the big hormonal transitions of life.

4 min read · 5 research sources · Based on the Mastering Migraine courses by Dr. Adam Harcourt

Because migraine responds to hormonal change, it often shifts at major life stages ¹.

Pregnancy

Many women, especially those with menstrual migraine, notice fewer attacks during pregnancy, particularly in the second and third trimesters when estrogen is high and steady. Attacks often return after delivery as hormones drop ². Migraine with aura may not improve as much. Any new or very different headache in pregnancy should be evaluated promptly, because other causes need to be ruled out (see When a headache needs urgent care).

Perimenopause

The years leading up to menopause bring unpredictable hormone swings, and migraine often gets worse during this time ^3,4.

Menopause and beyond

For many women, migraine improves after menopause once hormone levels settle, particularly after natural menopause. Surgical menopause tends to have a less favorable effect ^3,5. Hormone therapy can affect migraine in either direction, so decisions should be made with your physician ⁴.

Throughout life

Women with migraine face specific considerations at every stage, from contraception to pregnancy to cardiovascular health later in life ¹. See Birth control, aura and stroke risk.

This article is educational and does not replace a personal evaluation. Talk with your clinician before making changes to medications, supplements or diet.

Research cited on this page

Faubion SS, Batur P, Calhoun AH. Migraine Throughout the Female Reproductive Life Cycle. Mayo Clin Proc. 2018;93(5):639-645. PubMed 29728203 · DOI
Petrovski BÉ, Vetvik KG, Lundqvist C, et al. Characteristics of menstrual versus non-menstrual migraine during pregnancy: a longitudinal population-based study. J Headache Pain. 2018;19(1):27. PubMed 29611008 · DOI
Ripa P, Ornello R, Degan D, et al. Migraine in menopausal women: a systematic review. Int J Womens Health. 2015;7:773-82. PubMed 26316824 · DOI
MacGregor EA. Migraine, menopause and hormone replacement therapy. Post Reprod Health. 2018;24(1):11-18. PubMed 28994639 · DOI
Carturan P, Scorcine C, Fragoso YD. Migraine in the post-menopausal period is associated with higher levels of mood disorders, disability, and more menopausal symptoms. Arq Neuropsiquiatr. 2016;74(12):999-1002. PubMed 27991998 · DOI

Mastering Migraine is an educational resource and is not a substitute for individualized medical care. Always talk with your own doctor before changing medications, starting supplements, or beginning a new treatment.