What should you know about hormonal headaches in perimenopause?

Oestrogen can fluctuate during the menopause transition, and that change may trigger or alter headaches or migraine for some people. Sleep disruption, skipped meals, dehydration, stress, hot flushes and changing periods can add to the burden. Headache patterns may become more frequent, less predictable or different from earlier life.

A headache during perimenopause is not automatically caused by hormones. Infection, high blood pressure, medication overuse, vision problems and neurological conditions can also cause head pain. Heavy periods may contribute to iron deficiency, which can leave you tired and unwell, but the headache itself needs its own assessment.

Keep a diary of headache timing, severity, duration, period changes, sleep, food, fluids, stress, hot flushes and medicines. Regular meals, hydration, steady sleep and gentle activity may reduce common triggers. Use pain medicine only as directed; frequent use can itself maintain headaches.

Book a review if headaches are new, increasingly frequent, disabling or accompanied by visual symptoms. Tell the clinician whether you have aura, because that affects the safety of some hormonal treatments and contraceptives. A personalised plan may include non-hormonal treatment, migraine medicine or carefully selected hormone treatment.

Get emergency help for a sudden explosive headache, new weakness or numbness, trouble speaking, confusion, fainting, seizure, fever with a stiff neck, new vision loss or a severe headache after a head injury. These warning signs need immediate evaluation.

Arrange prompt medical advice for a new headache after midlife, a clear change in your usual migraine, headache with very high blood pressure, persistent vomiting or headaches that wake you repeatedly. Do not assume these are part of perimenopause.

Ask whether your symptoms fit migraine, tension headache or another pattern, whether blood pressure or blood tests are needed, and which pain medicines are appropriate. Discuss aura, contraception, hormone treatment, heavy periods and a plan for urgent symptoms.