The Migraine Trust explains how hormonal changes, during menstruation, pregnancy, menopause, contraception, and hormone therapies, can trigger migraine attacks and impact treatment strategies
Migraine is a complex neurological condition that affects millions of people worldwide, causing symptoms such as head pain, nausea, visual disturbances, and sensitivity to light, sound and smells. Research has shown that hormonal fluctuations, particularly involving the hormone oestrogen, can play a significant role in triggering migraine attacks. It’s one of the main reasons why migraine is so much more common in women.
This article explores how different life stages and medical treatments that alter hormone levels, such as menstruation, pregnancy, menopause, contraception, and hormone therapies, can influence the frequency and severity of migraine attacks.
Influence of oestrogen on migraine
Oestrogen, a primary female sex hormone, appears to have a direct effect on the pain pathways in the nervous system. Although the mechanisms are not yet fully understood, it is believed that fluctuations in oestrogen levels can heighten sensitivity to pain and trigger migraine attacks.
Any event or treatment that changes the body’s oestrogen levels has the potential to impact migraine. This includes natural hormonal changes such as those experienced during the menstrual cycle, pregnancy, and menopause. It also includes exogenous hormonal influences from medications such as hormonal contraceptives, hormone replacement therapy (HRT), fertility treatments, and gender-affirming hormone therapy for transgender individuals.
Migraine and the menstrual cycle
Menstruation is a very common hormone-related migraine trigger. It is estimated that up to two-thirds of women with migraine experience attacks in connection with their menstrual cycle. This type of migraine is referred to as menstrual migraine and is closely associated with the natural fall in oestrogen levels that occurs in the days leading up to a period.
There are two forms of menstrual migraine:
- Pure menstrual migraine, where migraine attacks occur only around the time of menstruation.
- Menstrually-related migraine, where attacks happen during menstruation but also at other times of the month.
Identifying a link between menstrual cycles and migraine can be helpful – keeping a symptom diary over at least three months is a good way to identify cycle-related triggers. This can help patients and healthcare providers determine whether hormonal fluctuations are contributing to migraine patterns, and guide management strategies.
“Starting typically 5 days before my period, I’ll experience a migraine attack with a dull ache followed by intense head pain, tightness across my neck, and sensitivity to movement and light. Then, when it lifts, I feel like I have been hit by a bus; the fatigue is immense.” – Maria, who lives with menstrual migraine.
Pregnancy and migraine
Pregnancy brings about significant hormonal changes, with steadily rising levels of oestrogen and progesterone, particularly during the second and third trimesters. Increased levels of natural pain-killing hormones, called endorphins, may also be observed. For many individuals, this results in a noticeable improvement in migraine symptoms, likely because the hormonal environment is more stable compared to the monthly fluctuations of the menstrual cycle.
However, experiences vary. Some people may find no change in their migraine frequency or severity during pregnancy, while others, especially those with migraine with aura, may notice a worsening of symptoms. After childbirth, migraine attacks can return within just a few days due to the rapid drop in oestrogen levels. Breastfeeding may delay this return, as oestrogen levels remain relatively stable during lactation.
“When I was pregnant the first time, I didn’t have migraine. Then, maybe 2 weeks post-partum, migraine returned, so it seemed to be very much linked to hormones. With my second baby, I was getting very bad attacks throughout pregnancy, maybe because this time around I was more tired since I was also running around with a toddler. I was very ill, though.” – Heather, who lives with migraine.
Migraine, menopause, and Hormone Replacement Therapy (HRT)
Menopause marks the natural end of menstrual cycles and is characterised by a decline in oestrogen and other hormones. The transitional period leading up to menopause, known as perimenopause, involves fluctuating hormone levels that can trigger migraine attacks. Many people find their migraine worsens during this time.
Post-menopause, when hormone levels stabilise, migraine symptoms often improve, although this is not the case for everyone. For some, migraine attacks persist or can even worsen after menopause.
Hormone Replacement Therapy (HRT) is often prescribed to alleviate menopausal symptoms, and its impact on migraine varies. Some individuals report improvement in migraine symptoms with HRT, while others experience worsening. The effect often depends on the type and dosage of HRT, and whether it causes rapid changes in oestrogen levels, with patches, gels and sprays more likely to provide stable hormone levels than tablets. Healthcare professionals can help determine the most suitable HRT option to minimise risk in patients with migraine.
Hormonal contraception and migraine
Hormonal contraceptives such as the combined oral contraceptive pill, the vaginal ring, or hormonal patches can affect migraine in different ways. Taking the combined pill with a seven-day break can cause oestrogen levels to drop sharply. This withdrawal can trigger migraine attacks in some people. Reducing the length or frequency of the pill-free interval can help manage this issue. Other hormonal contraception options such as the vaginal ring and patch are less likely to cause large changes in oestrogen levels, which may make them less likely to trigger a migraine attack.
Importantly, combined hormonal contraceptives are not recommended for individuals who experience migraine with aura, due to a small but significant increased risk of stroke. In these cases, non-oestrogen-containing contraceptive methods are usually safer alternatives.
Fertility treatments and transgender hormone therapy
Fertility treatments such as in vitro fertilisation (IVF) typically involve the use of hormone injections that raise oestrogen levels. These treatments can trigger or worsen migraine symptoms in some individuals.
Similarly, transgender people who take hormones as part of gender-affirming hormone therapy may experience changes in migraine patterns. Trans women taking oestrogen may experience an increase in frequency of migraine attacks, while trans men taking testosterone may experience a decrease in attack frequency. It is important for anyone undergoing hormone therapy to monitor changes in migraine symptoms and discuss them with a healthcare professional.
More research into the role of hormones in migraine is needed
Hormones, particularly oestrogen, play a pivotal role in migraine. A better understanding of exactly how both natural and exogenous hormones affect the migraine process is key to ensuring individuals receive suitable treatment, and The Migraine Trust has funded a number of studies to date in this area.
While the relationship between hormones and migraine is complex and varies from person to person, tracking symptoms, working closely with healthcare professionals, and exploring suitable treatment options can help mitigate the impact of the condition.
The Migraine Trust has lots of information on menstrual migraine, pregnancy, menopause, HRT, contraception, and other hormonal therapies in relation to migraine.
Migraine Awareness Week runs from 22-28 September 2025. This year, we are focusing on what migraine means, highlighting the misconceptions related to the condition alongside the reality for the one in seven living with it. More information and ways to get involved can be found here: https://migrainetrust.org/get-involved/campaign-with-us/migraine-awareness-week/
