Headaches can be fickle in nature. What triggers one person’s pain can cure someone else’s. For example, chocolate and caffeine can have different effects depending on the person. The same is true for your hormones.

Many women who experience hormonal headaches find relief during menopause. Other women may notice an uptick in headaches after they reach this phase of their lives. Here we’ll discuss the link between headaches and menopause, and offer tips to help improve your quality of life.

Menopause marks the official end of a woman’s fertility. It’s a completely natural process that generally happens between the ages of 45 and 55. When you’ve missed a year’s worth of periods (with no other obvious cause), you’re going through menopause.

The time leading up to menopause is called perimenopause. This could last for months or even years. Perimenopause is associated with a number of different symptoms. This includes:

  • vaginal dryness
  • hot flashes
  • night sweats
  • mood changes
  • thinning hair
  • weight gain

It’s possible, though not likely, to have a completely normal menstrual cycle up until the day your period stops entirely. More often than not, you’ll experience a normal period some months and skip your period other months. This is because of the hormonal fluctuations in your body.

As you approach menopause, your estrogen levels generally decline, though this may happen in an irregular fashion. Your body will also produce less progesterone and testosterone than in previous years. These hormonal fluctuations can affect your headaches.

Menopause can affect your headaches in several ways. The effects can be different for every woman, so you may not experience the same changes as someone else.

If your headaches are hormonal in nature, you may find relief after menopause. This may mean that you have less headaches or less severe headaches. This is because your hormone levels stay low, with little fluctuation, after your period stops for good.

On the other hand, some women have more frequent or worse headaches during perimenopause. It’s even possible for women who have never had problems with hormonal headaches to start having headaches during this time.

Women who experience migraines often report that their headaches are significantly worse during perimenopause, says Mark W. Green, M.D., director of the Center for Headache and Pain Medicine at Icahn School of Medicine at Mount Sinai. “This is particularly true of women who earlier had headaches worsening around periods and ovulation.”

Migraines are a subtype of headache. They’re typically the most debilitating in nature. They’re characterized by throbbing pain on one side of the head, as well as sensitivity to light or sound.

Estrogen withdrawal is a common trigger. This is why headaches can be worse around menstruation, Green says. The same hormone — or lack thereof — that gives some women relief from migraines after menopause can cause more headaches in the months leading up to it.

That’s because hormone levels such as estrogen and progesterone decline during perimenopause. This decline isn’t always consistent, so women who experience headaches related to their monthly menstrual cycle may have more headaches during perimenopause. It’s also common to experience more severe headaches during this time.

Your doctor may prescribe some form of hormone replacement therapy (HRT) to treat hot flashes or other symptoms related to menopause. How this treatment affects your headaches will be unique to you. It could help your migraines, or it could make them worse.

If you’ve noticed worsening headaches and are on HRT, you should tell your doctor. They may want you to try an estrogen skin patch instead. Estrogen patches may be less likely than other forms of HRT to trigger headaches. Your doctor may also suggest other treatment options.

A number of medications can help treat or even prevent migraines. Some are available over the counter. Others require a doctor’s prescription.

Diet and lifestyle changes can also help to reduce the number of headaches you have or alleviate your symptoms.

Diet changes

What you eat can have a huge impact on your headaches. Keep in mind that what triggers your headaches won’t be the same for someone else. Because of this, you may want to keep a food diary to determine what your headache triggers may be.

When you experience a headache, write down what you ate in the hours before. Over time this may help you find dietary patterns. If a pattern emerges, you should try limiting that item. From there, you can determine if cutting this out of your diet has an effect on your headaches.

Common dietary triggers include:

  • alcohol, especially red wine
  • aged cheeses, such as Parmesan
  • caffeine
  • chocolate
  • dairy products

Exercise

Regular physical activity may also help to prevent headaches. Aim for 30 minutes of exercise three to four times each week. Spinning or swimming classes are two great choices. A nice walk outside is easy and accessible, too.

It’s important to go slow in your activity goals. Let your body warm up gradually. Jumping into a high-intensity workout right away could actually trigger a headache.

Acupuncture

This is a form of alternative medicine that uses thin needles to stimulate your body’s energy pathways. Acupuncture stems from traditional Chinese medicine and is used to treat various types of pain. Views on its effectiveness are mixed, but you may find that it helps you.

Behavioral therapy

Biofeedback and relaxation therapies are two types of behavioral therapies known to help some people deal with severe headaches. These use different techniques to control how your body physically responds to stress, muscle tension, and even pain.

Cognitive behavioral therapy (CBT) is slightly different. CBT teaches you stress relief techniques, as well as how to better deal with stressors or pain. It’s often recommended that you pair CBT with biofeedback or relaxation therapy for best results.

Supplements

Certain nutritional supplements have shown some success in limiting headache frequency. Vitamin B-2, butterbur, and magnesium may be your best bets for headache prevention. Vitamin D and Coenzyme Q10 may also be beneficial. You should check with your doctor before adding these to your regimen to make sure you’re not taking any unnecessary risks.

Although it’s not guaranteed, menopause can bring many women relief from headaches once the hormonal roller coaster has officially stopped. Until then, you should work with your doctor to find the best combination of medications or lifestyle changes for you.

If you notice your headaches are becoming worse or interfering with your quality of life, you should speak with your doctor. They can rule out any other causes and, if necessary, adjust your treatment plan.