October is Menopause Awareness Month, and one symptom that rarely gets talked about is pain.
Maybe you’ve had the odd headache for years, but lately they come more often, last longer or hit harder. Or maybe migraines you thought you’d outgrown are back.
Here’s the short answer: headaches often change during perimenopause, the years leading up to menopause. Shifting hormones are a common reason, but not the only one. There are ways to manage them, and an assessment is the right first step.
Missed my free webinar, Is This Perimenopause? 10 Things Every Woman Should Know About the Midlife Shift? The recording is free to watch anytime. Get the recording here.
Can Perimenopause Cause Headaches?
Yes. Headaches and migraines often change during perimenopause, and for many women they get more frequent before they get better.
Research backs this up. A large study published in Headache followed more than 3,600 women with migraine. Those in perimenopause had about a 60% higher risk of headaches on 10 or more days a month than women whose cycles were still regular. The risk was highest in late perimenopause, when periods start to skip.
Some women notice their usual migraines changing. Others start having headaches they never had before. Both are common, and both are worth paying attention to.
Why Do Headaches Change in Midlife?
The main driver is change, not low hormones. Your brain is sensitive to shifts in estrogen, and perimenopause is a time of big, unpredictable swings.
Estrogen swings. Estrogen affects how your nervous system senses pain. When it rises and falls sharply, headaches can follow. That’s why many women have long had headaches around their period, and why those patterns can intensify as cycles become irregular.
Sleep. Night sweats and early-morning waking are common in midlife. Poor sleep is a well-known headache trigger.
Stress. Midlife is often a stretched season, and ongoing stress keeps your body on high alert.
Pain reliever use. Taking pain relievers on many days a month can sometimes lead to more headaches, not fewer. This is called medication-overuse headache, or “rebound” headache.
Usually it’s a mix of these, which is why looking at the whole picture matters.
What Do Perimenopause Headaches Look Like?
There’s no single type, but women often describe a change in their usual pattern.
- More often: headaches or migraines on more days each month.
- Harder to predict: they used to come with your period, and now they seem random.
- Longer or stronger: attacks that last longer or don’t respond as well to what used to work.
- Linked to sleep: headaches after a night of poor sleep or night sweats.
- Brand new: headaches in women who rarely had them before.
Noticing which of these fits you is useful information for your healthcare provider.
Will My Headaches Get Better After Menopause?
For many women, yes. Once hormones settle into a lower, steadier level after menopause, migraines often ease, according to the National Headache Foundation.
It isn’t guaranteed, though, and it doesn’t mean you need to wait it out. Perimenopause can last several years, and there are ways to manage headaches along the way.
When Should a Headache Be Checked Right Away?
Most midlife headaches aren’t dangerous, but some need prompt care. Seek medical help right away for:
- A sudden, severe headache, or the worst headache of your life
- A new type of headache after age 50
- Headache with fever, a stiff neck or a rash
- Headache with weakness, numbness, confusion, vision loss or trouble speaking
- Headache after a head injury
- Migraine aura that’s new, different or lasts more than an hour
If you have sudden weakness, trouble speaking or a sudden severe headache, call 911.
For headaches that are simply more frequent or different from before, book a visit with your family doctor to talk it through.
What Can Help?
There are several ways to manage midlife headaches. The first step is understanding your pattern, because what helps depends on what’s driving yours.
Getting clear on your pattern. A headache diary (see below) is one of the most useful tools you have.
Sleep and stress. Because both can trigger headaches, supporting them is part of the picture.
Reviewing pain reliever use. If you’re reaching for pain relievers often, talk with your provider about it, since frequent use can backfire.
Checking other contributors. Things like low iron, thyroid changes, blood pressure or eye strain can also play a role.
Acupuncture and bodywork. Some women find these helpful for easing tension.
Hormonal options. For some women, hormonal options are worth discussing with a provider. Be sure to mention if you have migraine with aura, since it matters for some options.
You can learn more on my Menopause & Perimenopause page.
What Should I Write in a Headache Diary?
Keep it simple. For a few weeks, jot down:
- Date, time and how long it lasted
- How bad it was (0 to 10) and where you felt it
- Where you are in your cycle, if you still have one
- How you slept the night before
- What you took for it, and how often you’ve taken it that week
Bring it to your appointment. A pattern says much more than a single bad day.
Frequently Asked Questions
Can you get migraines for the first time in your 40s?
Yes. Some women have their first migraines in perimenopause. Because a new type of headache can have other causes too, it’s worth getting it checked.
Can headaches be an early sign of perimenopause?
They can be. Headache changes sometimes show up before hot flashes or big changes in your cycle.
Is it okay to keep taking over-the-counter pain relievers?
Occasional use is common. If you’re taking them on many days a month, talk with your provider, since frequent use can lead to more headaches.
Does hormone therapy help or make headaches worse?
It can go either way, depending on the person and the type of therapy. It’s a conversation to have with your provider, especially if you have a migraine with aura.
The Takeaway
Headaches that change in your 40s or 50s aren’t something you just have to live with, and they aren’t always “just hormones” either. Understanding your pattern is the first step, and an assessment is a good place to start.
Watch the free webinar: Is This Perimenopause? 10 Things Every Woman Should Know About the Midlife Shift
Recorded October 13, 2026 · About 50 minutes · Free, watch anytime
Register now to get the free recording.
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My online course for navigating perimenopause and menopause. You’ll learn practical ways to support your metabolism and make sustainable changes for your health. You’ll also get a closer look at options for symptom support, including hormone therapy and natural and non-hormonal approaches, so you can feel more confident about what may be right for you. It includes a strength training plan and the Strong Through the Shift workbook as free bonuses.
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This article is general education and not individual medical advice. Please speak with your healthcare provider about your own situation.