During perimenopause and menopause

For many women who have had hormone-related headaches, migraines become more frequent and severe during perimenopause — the years leading up to menopause — because hormone levels rise and fall unevenly.

For some women, migraines improve once their menstrual periods stop, but tension headaches often get worse. If your headaches persist after menopause, you likely can continue to take your medications and use other therapies.

Hormone replacement therapy, which is sometimes used to treat perimenopause and menopause, can worsen headaches in some women, improve headaches in others or cause no changes. If you're taking hormone replacement therapy, your doctor might recommend an estrogen skin patch. The patch provides a low, steady supply of estrogen, which is least likely to aggravate headaches.

If hormone replacement therapy worsens your headaches, your doctor might lower the estrogen dose, change to a different form of estrogen or stop the hormone replacement therapy.