Headaches and the menopause: what’s the link?

Headaches are a common symptom during times of hormonal flux – here’s how to manage them

Headaches can be influenced by hormones and worsen during times of flux
Lifestyle adjustments can help alleviate symptoms
HRT can help manage menopause-related headaches

Most of us have experienced headaches at some point in our lives, and according to the World Health Organisation, up to 1 adult in 20 has a headache every, or nearly every, day [1]. They can vary enormously in type and cause, with some estimating there are as many as 150 different types of headache.

While a “brain freeze” headache from eating ice cream or experiencing a throbbing head the morning after drinking alcohol are thankfully short lived and pretty easy to prevent, other types of headache can be harder to pin down.

There are three main types of primary headache (where the headache itself is the main problem rather than a symptom of a disease or condition): tension, migraine and cluster.

Tension-type headaches, which can feel like a band of pain or pressure around the head that lasts from 30 minutes to a few hours, are the most common type of headache, affecting around 13 million people in the UK [2]. They are also more likely to affect women than men [3].

Migraines, which are moderate to severe headaches, feel like a throbbing pain and are usually accompanied by sensitivity to sound or light, and/or nausea. They are also more common in women (2-3 times so), with almost a quarter of women suffering from migraine, according to The Migraine Trust [4].

Cluster headaches – a severe headache that can occur multiple times a day over a period of weeks or months – are more common in men in their 30s and 40s, although peak occurrence in women is around the age of 20, and then age 50-60.

What causes headaches in women?

A review of articles over 20 years found sex hormones, including oestrogen, progesterone and testosterone, can have an important influence on the course of primary headaches [5].

Hormone headaches can be triggered by hormone changes associated with periods, the combined contraceptive pill, pregnancy and perimenopause and menopause. During perimenopause, hormonal headaches can worsen – owing to both the disruption of the hormonal cycle, with fluctuations of oestrogen and progesterone levels, and because periods can come more often.

The majority of female cluster headache patients experience their first attack after menopause [6], and while the reason for this onset is unclear it’s assumed that the constant low oestrogen levels may provoke them.

Tension headaches are known to be caused by stress and muscle tension, and menopause in itself is known to be a stressful experience for some women.

Fatigue and sleep disturbance can also trigger tension headaches but there is also a hormonal link. The 20-year review into the role of hormones found that in some women menstruation can trigger tension-type headaches and that perimenopausal women experience a higher prevalence of these headaches than premenopausal women.

Testosterone is another important hormone for women. Levels gradually decline with age and symptoms of testosterone deficiency can include headaches (as well as fatigue, loss of

concentration, impaired memory, brain fog, reduced energy, low mood, loss of muscle strength and reduced libido) [7].

How can I treat my headache?

If you are still having periods, keep a diary for at least three menstrual cycles to see if your headaches are linked – The Migraine Trust has a downloadable headache diary, which can help. Even if you are not having periods, it is worth keeping a diary to see if there are other triggers, including skipping meals, stress or lack of sleep.

Try to keep your blood sugar level stable by eating small, frequent snacks and avoid missing meals, which can lead to low blood sugar levels, which in turn can cause headaches. Get into a regular sleep pattern and try to manage stress as much as possible.

Regular exercise is thought to reduce the severity and frequency of headaches, including migraine – mild aerobic exercise may offer the most benefits.

Relaxation techniques can help with tension headaches, particularly massages that address any muscle tension around the neck and shoulders. Acupuncture can also help treat headaches and migraines.

RELATED: Acupuncture and menopause

HRT can help alleviate the symptoms of migraine, as well as the associated symptoms of menopause. It may also help with non-migraine headaches and it’s advised that continuous rather than cyclical doses is preferable where possible to keep hormone levels stable [8].

A number of medications can help manage headaches and often target the underlying cause, for example perimenopause or neck arthritis. Speak to a healthcare professional with a symptom and explain your headache in detail. This will help with the diagnosis of tension, migraine or cluster headache, and therefore guide treatment.

In many cases, women find that their headaches are worse during perimenopause but stabilise after menopause when oestrogen levels are also stable.

Finally, seek advice from a healthcare profession is your headache:

Progressively worsens
Has a sudden onset
Wakes you up from sleep
Is accompanied by a high fever or rash, or confusion, dizziness, or weakness
Is experienced alongside unexplained weight loss
Is different from all previous headaches you’ve experienced

RELATED: dizziness and the menopause

References

WHO: headache disorders: how common are headaches
Brain Research UK
Cairns, B. E., & Gazerani, P. (2009), ‘Sex-related differences in pain’, Maturitas, 63(4), pp. 292-296. Doi: https://doi.org/10.1016/j.maturitas.2009.06.004
Migraine Trust: women’s experience of migraine
Delaruelle, Z., Ivanova, T.A., Khan, S. et al. (2018), ‘Male and female sex hormones in primary headaches’, J Headache Pain, 19, 117. https://doi.org/10.1186/s10194-018-0922-7
Lieba-Samal, D. & Wöber, C. (2011), ‘Sex hormones and primary headaches other than migraine’, Current pain and headache reports, 15: pp. 407-414. Doi:10.1007/s11916-011-0211-5
Glaser, R., Dimitrakakis, C. (2013), ‘Testosterone therapy in women: myths and misconceptions’, Maturitas, 74 (3), pp. 230–4. doi: 10.1016/j.maturitas.2013.01.003
Lauritsen, C.G., Chua, A.L. & Nahas, S.J. (2018), ‘Current Treatment Options: Headache Related to Menopause—Diagnosis and Management’, Curr Treat Options Neurol, 20, 7, https://doi.org/10.1007/s11940-018-0492-7