Migraine and the Menopause Transition

Migraine is a prevalent neurologic disorder affecting 42 million people in the U.S., with women experiencing it three times more than men, largely due to hormonal fluctuations. During perimenopause, many women report increased migraine frequency and intensity, with changes in migraine characteristics such as the development of aura. Although migraine prevalence declines after age 60, about 50% of women continue to experience it postmenopause. Migraine with aura is linked to a higher risk of ischemic stroke, especially when combined with hormone contraceptives. While hormone therapy may stabilize estrogen levels and potentially benefit migraines during perimenopause, there is no strong evidence supporting its use solely for migraine control. Safe pharmacologic and integrative management options are available, and new-onset migraines in midlife women should be carefully evaluated to exclude secondary causes.