"Why are my migraines getting worse?" The role of hormones
Are your migraines becoming more frequent, more painful or harder to predict? Perhaps you’re cancelling plans, missing work or spending hours in a dark room, wondering why something you’ve managed for years suddenly feels harder to cope with.
We know this can be incredibly isolating and frustrating, but you aren’t alone.
At Newson Clinic, we often hear from women whose migraines have worsened alongside changes in their periods, sleep or mood. Fluctuating hormones are a recognised migraine trigger, and understanding this connection can help explain what’s happening. Our clinicians explore these patterns alongside your medical history and existing medicines to assess whether hormones are contributing.
Our patient-led data found that, among women who reported migraines at their initial appointment, average migraine severity was 49% lower at follow-up around three months after starting individualised bioidentical hormone treatment.
In this article, we explain how hormones affect migraines, why attacks can change at different stages of life and the treatment available.
Book an appointment to discuss changes in your migraines alongside other hormonal symptoms.
How do hormones affect migraines?
Migraine affects the brain and nerves. Alongside head pain, attacks can cause nausea, sensitivity to light or sound, exhaustion and difficulty concentrating. Some people experience aura, such as flashing lights or tingling, sometimes without a headache.
The hormones estradiol, progesterone and testosterone influence how your brain works, including how it processes pain and responds to potential migraine triggers.
The connection is best understood for estradiol, a beneficial form of estrogen produced mainly by the ovaries. It affects chemical messengers involved in pain, mood and sleep, including serotonin. When estradiol falls rapidly, your brain can become more sensitive to pain, increasing the likelihood of a migraine attack.1
For women sensitive to hormonal changes, it’s often the rise and fall in hormone levels, rather than simply a low level, that triggers an attack.
This helps explain why migraines can follow a monthly pattern or become harder to predict during perimenopause.
Why do I get migraines around my period?
Just before your period, estradiol levels fall. In women sensitive to this drop, it can trigger a menstrual migraine, sometimes called a period migraine.
These attacks are often longer and harder to treat than migraines occurring elsewhere in the cycle. Some women experience attacks only around menstruation; others also have migraines at other times.
While these attacks can follow a recognisable monthly pattern, the hormonal changes of perimenopause can make that pattern less predictable.
Living with migraines can affect more than your physical health. Worrying about the next attack can take a toll on your mental wellbeing. If you’ve also noticed changes in your mood or anxiety, our article on hormones and mental health explores this connection in more detail.
Many think hormonal headaches only happen around your period, but changes in hormone levels can affect headache patterns at other stages of life too, including perimenopause.
If a period migraine regularly disrupts your life alongside other hormonal symptoms, book an appointment with an expert at Newson Clinic to discuss your experience.
Why do migraines get worse during perimenopause?
During perimenopause, hormone levels rise and fall less predictably. Previously familiar migraines can become more frequent, severe or difficult to anticipate.
With perimenopause migraine, other symptoms can add to the difficulty. Night sweats interrupt sleep, tiredness makes everyday tasks harder, and anxiety can leave you worrying about the next attack. Poor sleep is also a migraine trigger.
Dr Louise Newson’s sleep and hormones article explains why nights can become more disrupted.
Part of that assessment involves understanding the headaches themselves, as not every headache experienced during perimenopause is a migraine. If hormonal headaches regularly disrupt your life alongside other hormonal symptoms, book an appointment to discuss your experience.
How do I know whether my headache is a migraine?
Perimenopause headaches and menopause headaches have several possible causes. Recognising the features of migraine helps guide treatment.
An attack usually lasts between four and 72 hours and can involve:
- Throbbing head pain, often on one side.
- Feeling sick or being sick.
- Sensitivity to light, sound or smells.
- Pain that gets worse when you move.
Aura can include temporary visual symptoms, such as flashing lights or zigzag patterns, or changes in sensation, such as tingling. Tiredness and difficulty concentrating can begin before the pain, while exhaustion can continue afterwards.
New or changing headaches need assessment, even when they occur alongside hormonal symptoms. Read Dr Louise Newson’s guide to migraines for more on symptoms, triggers and treatment.
Understanding the type of headache, when it occurs and what else has changed helps your clinician discuss the most appropriate support.
You might describe these as hormonal headaches, but understanding whether they are migraines or another type of headache helps guide treatment.
When you’re a patient at Newson Clinic, you can regularly review your symptoms and treatment through follow-up appointments, keeping your clinician updated on how you’re feeling and discussing any adjustments needed.
How can Newson Clinic help?
Whether you’re experiencing menstrual migraine, worsening perimenopause headaches or persistent menopause headaches, our clinicians will take time to understand what has changed and how it affects your life.
Together, you can discuss whether bioidentical hormone treatment is something you’d like to explore. Prescribed at the right dose and in the right combination, it can help reduce migraine frequency and severity for some women by replacing hormones and providing steadier levels.2
Early research also suggests testosterone could help with migraine symptoms too, so this may be added into your regimen, where appropriate.3
