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Menopause is the natural process of the end of a woman’s menstrual cycles and fertility, and it is associated with a decline in oestrogen and few other hormones. Migraines are a type of headache disorder that can cause severe and recurrent headaches, often accompanied by other symptoms such as nausea and sensitivity to light and sound. There is a potential connection between menopause and migraines. The hormonal changes of menopause can affect the frequency and severity of migraines, and some women may experience changes in their migraine pattern during the menopause transition.
The relationship between migraines and female sex hormones is a complex one. While declining oestrogen or lack of oestrogen or fluctuations of oestrogen levels can trigger migraines, excess oestrogen from hormones or hormone-related products can also cause migraines. There are various types and subtypes of migraines. Some are related to hormones and others are not. Every woman’s susceptibility, trigger factors and experience of migraines from menarche to menopause are unique. There are various measures to prevent or manage migraines – lifestyle changes, avoiding triggers, eating healthy and timely, ensuring hydration, non-hormonal medications (analgesics, triptans, antiemetics, beta-blockers) and hormones.
Oestrogen plays a role in the regulation of the chemicals and processes in the brain that is involved in migraine attacks. The decline in estrogen levels during menopause can affect the frequency and intensity of migraines, and some women may experience an increase in the number of migraines during menopause.

Additionally, the symptoms of menopause, such as hot flushes and night sweats, can trigger or worsen migraines. The sleep disturbances, mood changes, and irritability of menopause can also affect migraine attacks.

Lifestyle interventions that can help with Menopause related Migraines

Lifestyle interventions that can help with Menopause related Migraines:

1. Phytoestrogens: found in lots of foods and dietary supplements, phytoestrogens are seen as a natural alternative to oestrogen replacement therapy. Foods high in these can include:

  • Soy and Soy products (tofu, miso, tempeh),
  • Legumes (chickpeas, mung beans, Lentils
  • Seeds (flaxseeds, sunflower seeds, sesame seeds),
  • Grains (oats, rice, quinoa, rye), and
  • Cruciferous Vegetables (broccoli, Brussel sprouts, cabbage)

2. Exercise – regular, intense exercise can help to moderate estrogen levels. Exercise is also good for decreasing stress, improving mental health and improving physical health and well-being.
3. Keeping a healthy diet – making sure you are maintaining a balanced diet of fruit, vegetables, and protein full of vitamins and minerals can help regulate hormone levels and overall bodily health.

For many women, migraines triggered by fluctuating or declining oestrogen levels during the menopause transition can respond to HRT alongside other menopause symptoms as HRT tends to stabilize hormone levels. Continuous combined HRT usually administered through the skin (gel/patch/spray) is usually preferred. For other women, avoiding too much of oestrogen in HRT is equally important to avoid migraines as a side effect. Individualizing the treatment regimen and optimizing the dose and route of hormones are key to achieving a balance between symptom suppression and unpleasant side effects.

It is important for women experiencing migraines to discuss their symptoms and treatment options with a healthcare provider during the menopause transition. This can include adjusting migraine medication and management plans to account for the potential effects of menopause on migraines. Additionally, women can manage their symptoms by maintaining a healthy and balanced diet, staying hydrated, getting regular exercise, and practicing relaxation techniques to manage stress and improve sleep.