Perimenopause headaches: Why they happen and how to cope

Depending on whether it’s more of a dull thud or a searing pain, headaches can range from being a little inconvenient to completely debilitating. Headaches are a common complaint, and lots of things could be the cause, including staring at a screen all day, eating triggering foods, or stress. But if you’re anywhere between your late 30s or 50s and it feels like you can’t seem to shake your sore head — plus you’ve noticed irregular periods lately — there’s a chance it might be linked to perimenopause.

If your headaches do turn out to be linked to your transition to menopause, there are plenty of ways to manage the pain. So you don’t have to live at the mercy of your hormones. Here, obstetrician, gynecologist, and attending physician Dr. Angela Jones, New Jersey, US, shares everything you need to know about perimenopause headaches. But if you notice your headaches are getting worse or interfering with your quality of life, it’s a good idea to reach out to your doctor.

Key takeaways

• Up to 1 in 20 people regularly get headaches, and 1 in 7 people also get migraines.
• Migraines are a particularly severe type of headache that can feel like throbbing pain. They’re three times more common in women, especially between the ages of 35 and 45 (overlapping with a common time for perimenopause to start).
• Changing hormone levels are thought to be the biggest cause of headaches in the journey to menopause.
• Lifestyle changes like exercising regularly, getting plenty of sleep, and drinking enough water can all help.
• Hormone therapy (HT) can be prescribed if you have other perimenopause symptoms such as hot flashes. As a bonus, it has been found to ease perimenopause headaches for some people. But it can also worsen symptoms for others, so chat with your doctor to figure out what treatment could be right for you.

Does perimenopause cause headaches?

If you’ve ever had a headache around the time of your period, during pregnancy, or after starting or stopping birth control, you might have already noticed the link between headaches and your hormones.

Hormone-related headaches can strike at different times throughout your life, but they are known to happen more often in the years leading up to menopause (your last period). This time is known as perimenopause. “Perimenopausal headaches are associated with the fluctuating hormonal levels associated with the transition to menopause,” says Dr. Jones. 

So, if you’re somewhere between your late 30s and 50s, and you’ve been getting headaches more than usual as well as irregular periods, it could be a sign that your hormones are changing, signaling the start of your journey toward menopause. 

It can take between four and eight years from the start of perimenopause until you reach menopause — everyone’s different — but on average, the transition lasts about four years. Once your period has stopped for good (you’ll know for certain when 12 months pass without having one), you will have gone through menopause. This usually happens between the ages of 45 and 55. 

Shifting hormones are thought to be responsible for a number of perimenopause symptoms like changes to your cycle, hot flashes and mood swings — and it’s the same with headaches. If you already get headaches or migraines before perimenopause, it’s possible that they might get worse. “The rise and fall of hormones such as estrogen and progesterone that is common during this phase of life can cause headaches to become more frequent and severe,” adds Dr. Jones.

While symptoms differ for everyone, headaches can be draining. “Perimenopause headaches are often characterized by a throbbing pain on one side of your head,” explains Dr. Jones, adding: “[You] may or may not [have] an increased sensitivity to light and sound.”

If this sounds familiar and you’re finding it difficult to cope, treatments are available to help you manage the pain, so speak to your doctor. It can help to show your doctor a log of your headaches and any other symptoms you get when you’re going through perimenopause — that’s where a cycle-tracking app like Flo can be useful. In the app, you can keep track of symptoms like brain fog and vaginal dryness alongside headaches and nausea. Plus, you can talk to others in perimenopause in our anonymous Secret Chats space.

What else can cause headaches? 

The occasional headache is usually nothing to worry about. But if they become regular, don’t ignore them. You can get headaches for reasons other than perimenopause, so it’s always worth getting a headache that keeps coming back checked out by your doctor.

“There are many causes of headaches,” says Dr. Jones. “[These include] stress, alcohol, caffeine withdrawal, lack of sleep, certain foods such as processed meats containing nitrates, environmental factors such as bright lights, smoke, and certain intense scents,” she adds.

More rarely, headaches can be a sign of a medical issue that needs treatment. Reach out to your doctor right away if you experience any of the following:

• Headaches that become more severe or more frequent than normal
• Pain that does not improve after taking over-the-counter pain relief (such as ibuprofen or acetaminophen)
• Headaches that prevent you from working, sleeping, or going about your daily life
• Other symptoms like a fever, shortness of breath, a stiff neck, or a rash

What helps with perimenopause headaches?

If you’ve got headaches during perimenopause and you’re finding them tricky to manage, there are few things that can help: 

Cool the area

Applying a cold compress, ice pack, or cooling gel directly to your head can relieve headache pain. Resting in a dark room, gently massaging your scalp, and trying relaxation techniques like meditation and yoga can also help to ease painful headaches.

Exercise regularly 

Anything that gets your heart pumping and strengthens your muscles can help with perimenopause symptoms generally. Research has also found that regular exercise can make migraines strike less severely, so it could be something to try, whatever the type of headache you get.

You’ll be more likely to exercise if you find something you enjoy, so experiment with different things, such as running, cycling, or gym classes, until you find the right activity for you. And if you can’t face the idea of getting majorly sweaty, try going for a walk. Studies suggest gentle aerobic exercise can also work for migraine relief.

Prioritize self-care

Lots of us are juggling different life stresses by the time we reach our 40s, whether it’s parenting, caring for aging parents, or working demanding jobs. However, stress has been found to impact perimenopause symptoms, so focusing on self-care may ease your symptoms. “Exercising regularly, not skipping meals, and eating healthily, as well as reducing stress may prove to be helpful,” says Dr. Jone

“If stress is the culprit, relaxation techniques/exercises may help relieve [it],” she adds. People have different ways of soothing themselves at stressful times. Exercises such as yoga and walking may help to clear your head, or perhaps hanging out with a good friend might lift your mood, reducing stress at the same time. “Acupuncture has also shown to be helpful,” adds Dr. Jones.

Get plenty of sleep (if you can)

Sleep is essential for every system in our bodies, yet 40% to 56% of women experience exhaustion and sleep disturbances during perimenopause. It’s not surprising, considering lots of people are woken up by hot flashes at night (aka night sweats) at this time in their lives. Not getting enough sleep can impact health in different ways, including causing headaches.

It may be easier said than done, but try to give yourself the best chance of a good night’s sleep in any way you can. Focusing on healthy sleep habits like these can help:

• Stick to a consistent bedtime routine. Going to bed and getting up at the same time every day can train your brain to naturally feel tired at night.
• If night sweats are messing with your sleep, try keeping your thermostat slightly lower than usual or open a window.
• Consider investing in lightweight and breathable bedding to keep you cool at night. 
• Cutting out alcohol, caffeine, and spicy foods in the evening can also help, as these can all cause your temperature to spike. Avoid smoking for this reason, too.

Drink lots of water

Changing estrogen levels during perimenopause can affect your sense of thirst. If you drink less, you’re more likely to become dehydrated, which can make your headaches worse. At a very general level, it’s recommended that we consume (via eating or drinking) about 11.5 cups (2.7 liters) of water per day. But more recent research shows that everyone needs to take in a different amount of water, so talk to your doctor about what’s right for you.

What you drink is also important, too. Caffeine can trigger migraines for some people. But if you have a regular coffee habit, cutting caffeine out suddenly can also lead to withdrawal headaches, so wean yourself off slowly. Research suggests that headache sufferers who normally drink coffee should stick to around 200 mg (around two cups) a day.

Consider hormone therapy (if you have other symptoms)

If your headaches are popping up alongside other telltale perimenopause symptoms, such as hot flashes, your doctor may recommend hormone therapy. HT works by boosting your levels of hormones, which naturally shift during this time.

“Hormone therapy may be helpful in treating headaches if hormonal fluctuations are thought to be the cause,” explains Dr. Jones, who adds that not everyone will be able to take it depending on their medical histories.

As with many things, there are pros and cons of hormone therapy. Research has found that HT may worsen migraines for some people, so chat with your doctor to figure out what treatment could be right for you.

Speak to your doctor

If you get the occasional perimenopause headache, taking over-the-counter pain relief should usually fix it (although you should be careful not to take certain pain medication for too long, as it could lead to headaches in the long term). But if headaches are affecting your daily life, it’s a good idea to ask your doctor for help. They might prescribe painkillers you can’t buy over the counter, but make sure you follow their advice on how long to take these medications so you’re not at risk of any other complications.

What else to watch for as you transition to menopause

Everyone’s experience of perimenopause is different. Not everyone has a hard time, and there’s no definitive symptom checklist for this life stage. All we know for sure is that some people react to hormonal changes more than others, which can sometimes make symptoms feel more difficult to manage. That’s why it’s so important to call on your doctor for help and support should you need it.

That said, most people experience at least one of the following symptoms at some point during their menopause journey:

• Irregular or missed periods or periods that are heavier or lighter than usual
• Hot flashes that feel like sudden, uncomfortable waves of heat and may come with heart palpitations and dizziness
• Brain fog that might feel like a lack of focus, poor memory, or difficulty concentrating
• Mood swings, including low mood, irritability, tearfulness, and reduced energy levels
• Joint pain or stiffness
• Vaginal dryness and discomfort during sex
• Problems falling or staying asleep, often as a result of hot flashes at night (night sweats)
• Reduced sex drive

You might find that your headaches (and other symptoms) improve after reaching menopause once your hormones settle. But this isn’t always the case because everyone reacts differently. If your headaches or any other symptoms continue postmenopause, reach out to your doctor for help in finding a solution.