A perimenopause woman with a headache. — Can perimenopause cause more migraines?

Yes. During perimenopause, fluctuating estrogen levels, sleep disruption, and increased stress sensitivity can all trigger more frequent or severe migraines. Understanding your pattern helps tailor acute and preventive treatments that actually work—especially when managed by a clinician experienced in both migraine and midlife women’s health.

Last Reviewed: September 09, 2025

If your migraines are changing in your 40s, you are not imagining it. Perimenopause is a period of shifting hormones that can make headaches more frequent, more intense, or simply different than what you have known. The good news is that there are effective ways to understand your pattern and reduce the number of migraine days. This guide explains why perimenopause influences migraine, the most common triggers, the full menu of treatment options, and when to seek more help. If you live in West Austin, Elevated Health offers a personalized approach that blends women’s health expertise with accessible primary care.

Why does perimenopause change migraines?

Estrogen levels fluctuate throughout perimenopause. For many women, rapid drops in estrogen act as a trigger, which is why headaches often cluster before a period or after a skipped cycle. Ovulation can be irregular, sleep can be disrupted, and stress loads often increase in midlife. That combination sets up a more sensitive nervous system. Understanding that biology helps you choose therapies that stabilize the pattern rather than only chasing pain after it starts.

The most common perimenopause migraine triggers

Every person has a unique mix of triggers, but the following are frequent culprits during the transition to menopause:

Hormonal shifts. Irregular ovulation and estrogen withdrawal around delayed or missed cycles.
Sleep disruption. Night sweats, snoring, and fragmented sleep lower the threshold for pain.
Stress and sensory load. Back-to-back meetings, bright screens, or noisy environments.
Dehydration and heat. Easy to underestimate in Austin, especially during warm months.
Skipped meals and blood sugar swings. Long meetings or travel days without protein or fiber.
Alcohol and certain foods. Red wine, aged cheeses, or highly processed snacks are for some people.
Medication overuse. Using over-the-counter pain relievers or triptans more than recommended can create rebound headaches.

You do not need to eliminate everything you enjoy. The goal is to identify the two or three triggers that matter most for you and plan around them.

Track your pattern for two cycles

A simple log is the fastest way to make progress. For two menstrual cycles, record the date, time of onset, suspected triggers, severity, medications used, and whether you experienced an aura. Include sleep hours, alcohol, hydration, and menstrual changes. Patterns often pop quickly. You might notice headaches two days before a period, clusters after a skipped cycle, or attacks tied to short sleep. Bring this log to your first visit. It turns guesswork into a strategy.

Acute treatments that stop a migraine in its tracks

You should have a clear step plan for treating pain at the first sign of a migraine. Options include:

Nonprescription first step. Many patients start with an NSAID or acetaminophen at onset, especially if the pain is mild and there is no history of stomach, kidney, or liver disease.
Triptans. Longstanding, effective options for moderate to severe attacks when used early and within recommended limits. Tablets, dissolvable forms, and nasal sprays exist.
Gepants for acute use. Newer calcitonin gene-related peptide blockers can help when triptans are not tolerated or are ineffective. Some are tablets, and one is a nasal spray.
Ditans. A serotonin agonist that may be considered for patients who cannot use triptans.
Antiemetics. Nausea medicines can be added when digestive symptoms make oral treatment difficult.
Rescue plan. If an attack breaks through, a backup such as a different class of medication or an in-office option can prevent prolonged disability.

The key is to treat early, avoid exceeding use limits, and have a backup ready so you do not slide into a multi-day cycle.

Preventive strategies that cut monthly migraine days

If you experience four or more migraine days per month, significant disability, or frequent need for acute medication, prevention can change the trajectory. Your plan may include:

Lifestyle anchors. Consistent sleep and wake times, hydration targets, regular meals with protein and fiber, and daily movement. Even a 20-minute walk and two brief strength sessions per week improve resilience.
Supplements with supportive evidence. Magnesium glycinate, riboflavin, and coenzyme Q10 are commonly used. Doses and interactions should be reviewed with your physician.
Prescription preventives. Options include beta blockers, anticonvulsants such as topiramate, and certain antidepressants that can reduce frequency and intensity.
CGRP-targeting therapies. Monoclonal antibodies given monthly or quarterly, and oral preventives in the same pathway, are well tolerated by many patients and specifically designed for migraine.
OnabotulinumtoxinA for chronic migraine. Considered when headaches occur 15 or more days per month, with at least eight migraine days.
Perimenopause-specific approaches. For some women, regulating their cycle or using continuous dosing strategies can help smooth hormonal fluctuations. Decisions about contraceptives or menopausal hormone therapy depend on your history, blood pressure, smoking status, and whether you have migraine with aura. This is a nuanced conversation best handled with a clinician who manages both midlife care and migraine.

Effective prevention rarely relies on one tool. The winning recipe often combines two or three modest changes that work together.

Special considerations in midlife

Perimenopause adds a few essential safety checkpoints:

Migraine with aura and estrogen use. Aura changes risk calculations. If you have a visual or sensory aura, your clinician will weigh contraceptive options and any potential use of systemic estrogen carefully. Do not start or stop hormones without guidance.
New or different headaches after 40. Sudden changes deserve a thorough evaluation rather than assumptions. Blood pressure, thyroid function, iron levels, and sleep apnea can all play a role.
Bone, heart, and metabolic health. Your migraine plan should not live in a silo. Screening for cardiovascular risk, bone density when appropriate, and metabolic markers matters in midlife.
Medication interactions. Review all prescriptions and supplements, especially if you take triptans, antidepressants, or preventive therapies.

When to escalate care

Call promptly or seek urgent care if you have a first or worst headache, a thunderclap onset, new weakness or numbness, confusion, high fever, or a change in vision that does not resolve. Schedule a dedicated visit if you notice any of the following:

Headaches occur more than four days per month.
Attacks last longer than 72 hours or repeatedly recur after brief relief.
You need acute medication more than two days per week.
The pattern has changed after a missed period or new bleeding abnormalities.
New aura symptoms appear, especially if you have never had aura before.

Early escalation prevents entrenched cycles and allows your team to adjust the plan before migraines take over your calendar.

How Elevated Health personalizes therapy in Westlake Hills

Women in Austin often juggle demanding schedules, caregiving roles, and travel. You need a realistic plan, not a list of impossible rules. Elevated Health is a concierge internal medicine practice in Austin led by Dr. Sonia Durairaj, who focuses on women’s health through midlife. Here is how we help:

Unhurried onboarding. Your first visit is a comprehensive conversation and examination that includes a review of your migraine history, hormone levels, sleep patterns, nutrition, and stress levels.
Data-driven plan. We translate your log into a personalized step plan for acute care and a preventive strategy tailored to your lifestyle. If CGRP therapy, onabotulinumtoxinA, or cycle regulation makes sense, we discuss benefits, risks, and practical details.
Coordination across Austin. When imaging, neurology input, sleep testing, pelvic health, or nutrition support is needed, we coordinate referrals and keep you informed.
Fast access when it counts. Same or next day appointments when headaches flare, secure messaging for quick questions, and clear follow-up after labs or medication changes.
Membership options. Choose a comprehensive Internal Medicine membership or a dedicated Women’s Health and Menopause Membership if you want targeted midlife support alongside your existing PCP.

You do not have to sort this out alone. With a smaller panel and direct communication, your questions do not wait weeks for answers.

Take the next step toward fewer migraine days

If perimenopause has changed your migraines, you deserve a plan that reflects your biology and your real life. Elevated Health offers evidence-informed care, clear communication, and access that works for busy adults in Westlake Hills and the surrounding Austin neighborhoods. To learn whether our approach is right for you, call 512-759-6033 or explore Membership & Services on the Elevated Health website. Schedule a short discovery conversation and let us help you personalize therapy for fewer migraine days and better days overall.