Perimenopause headaches: what to know

Hormone fluctuations during the menopause transition can affect people who already have migraine or tension-type headaches. Irregular periods, missed periods, hot flushes, night sweats, dehydration, skipped meals and broken sleep may all change when or how pain appears. Pain may be throbbing or pressing and can occur with nausea, light sensitivity or neck and scalp tension.

A headache is not proof of perimenopause. Blood pressure problems, infection, vision strain, medication overuse and other neurological conditions can also cause head pain. Note the location, severity, duration, associated symptoms and relationship to bleeding or sleep.

Keep regular food, fluids and sleep where possible, and record headache days, triggers, period changes and medicines used. A quiet dark room, a cool pack and gentle neck relaxation may help some people. Use pain medicines only as directed; frequent use can itself maintain headaches, so ask a clinician or pharmacist for a safer plan.

If headaches are recurring, a clinician can distinguish migraine from other patterns and discuss preventive treatment. Mention pregnancy possibility, contraception, hormone treatment and any history of migraine with aura before choosing medicines.

Seek urgent care for a sudden explosive headache, new weakness or numbness, trouble speaking, confusion, fainting, seizure, fever with a stiff neck, repeated vomiting, a new headache after a head injury, or severe pain with vision loss. Arrange a clinical review for a new pattern, steadily worsening headaches, headaches that wake you, or pain that is affecting ordinary activities.

Ask: Does this pattern resemble migraine or another headache type? Could my sleep, bleeding or medicines be contributing? What should I take at the first sign of pain? Do I need preventive treatment or an examination? Which warning signs should send me to urgent care?