Why Menopause Doesn't Always Mean the End of Migraines

Anyone who experiences migraine attacks—characterized by intense headache, dizziness, sensitivity to light and smells, vomiting, and irritability—knows how much they can compromise social, family, and professional life. The World Health Organization (WHO) classifies the condition as the second most disabling in the world , behind only back pain.

Women are more affected, mainly due to hormonal influences. "It's estimated that the disease affects one-third of men and two-thirds of women," highlights neurologist Tiago de Paula, a member of the International Headache Society (IHS) and the Brazilian Headache Society (SBC), who specializes in headaches. "Although it's a genetic condition, hormones like estrogen influence the sensitivity and prevalence of symptoms." Therefore, it's common to believe that attacks decrease with the onset of menopause—a period when female hormone levels drop sharply.

In fact, for about two-thirds of women, this phase can represent a significant reduction in the frequency and intensity of episodes. However, relief isn't the norm. "During the transition to menopause, women often suffer more from the disease due to the hormonal fluctuations typical of this phase. Over time, these substances stabilize at lower levels for a while, and the attacks tend to improve," explains gynecologist Helena Hachul, professor of Women's Health at the Einstein Hospital Israelita School of Medicine.

Even so, it's essential that women suffering from this condition continue to seek treatment. "Migraine is a complex illness that can persist in the form of dizziness, sleep disturbances, muscle pain, mood swings, and even hot flashes with neurological origins—factors that shouldn't be ignored," warns Tiago de Paula.

Hence the importance of seeking help at all stages of life, preventing the condition from becoming chronic. "It's important to analyze the context of menopause: whether the woman stopped menstruating altogether or went through a transition with significant hormonal fluctuations, for example. The doctor will also assess the symptoms, whether there's a change in the pattern of the attacks, how long they last, whether the pain is throbbing, among other factors. All of this helps direct and recommend the best treatment," says the gynecologist at Einstein.

During these appointments, doctors also identify factors that may be worsening the condition, such as excessive use of headache medications. Often, these medications don't resolve the problem and can even cause a rebound effect, intensifying the discomfort.

This personalized assessment can also prevent the situation from worsening. "A crucial point is hormone replacement therapy: many menopausal women are advised to replace estrogen to relieve hormonal symptoms, but in patients with migraine with aura, this replacement may pose an increased risk of cardiovascular events and stroke," warns the neurologist.

Maintaining healthy habits—such as adequate hydration, quality sleep, a balanced diet, and regular physical activity—is essential to reducing the risk of flare-ups. "It's also important to avoid factors like stress and alcohol consumption at this stage of life," advises Hachul.

Source: Einstein Agency

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