- Researchers say migraine symptoms can increase during menopause but tend to decrease after menopause.
- They say migraine can affect the sleep quality in people of any age.
- Experts say there are medications that can ease migraine symptoms as well as lifestyle changes that can improve sleep quality.
A new study reports that transitioning to menopause can increase migraine symptoms, especially in women with a history of migraine due to hormonal changes during their menstrual cycle.
For these women, headaches can lessen after menopause, except for women taking hormone replacement therapy.
In their study, researchers examined the association between migraine and sleep quality in premenopausal women and compared the results to those of perimenopausal women.
The researchers looked at information for more than 2,000 female participants. They will present the results at the North American Menopause Society annual meeting being held this week.
The findings have not been published yet in a peer-reviewed journal.
Sleep and migraine
The researchers said their study reinforced previous information showing a relationship between poor sleep and migraine.
For women who have not yet gone through menopause, poor sleep seemed to be a migraine trigger. However, the researchers said this is not necessarily true for both premenopausal and perimenopausal women.
For premenopausal women, body mass index, anxiety, depression, and hot flashes were more likely to contribute to poor sleep quality but were not migraine triggers, the researchers noted.
“Clinical observations, supported by studies, suggest that migraine generally worsens during the menopause transition and improves post-menopause,” said Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California.
“A perimenopause-related increase in comorbid conditions like anxiety, depression, and sleep disturbance can also worsen migraine,” he told Healthline.
Previous studies have not shown an association between migraine and sleep apnea.
“But, individuals with sleep apnea can experience morning headaches caused by nighttime hypoxia (low oxygen levels) due to sleep apnea,” explained Dr. Alex Dimitriu, an expert in psychiatry and sleep medicine and the founder of Menlo Park Psychiatry & Sleep Medicine in California and BrainfoodMD.
“These morning headaches should be distinguished from migraine headaches,” he told Healthline.
What to know about migraine
Migraine is a neurological disease. The American Migraine Foundation estimates that at least 39 million people in the United States live with these types of headaches.
Symptoms can appear differently depending on the person, but common symptoms include:
- Throbbing, pounding, or pulsating head pain
- Pain getting worse with physical activity or any movement
- Nausea or vomiting accompanying the pain
- Sensitivity to light, sounds, and smells
- Headaches lasting from several hours to several days
- Pain on one side of the head or in the front or back of the head
Women have migraine more frequently and with a higher level of disability than men, according to a report published in 2020. Around 43 percent of women experience migraine sometime in their lifetime compared to 18 percent of men.
Fluctuations in hormones, especially estrogen, can cause more frequent and more severe migraine in women shortly before or during the menstrual cycle, after childbirth, or during the menopausal transition.
Treatments and therapies for migraine
Migraine is a genetic, neurological disease, according to the American Migraine Foundation.
Triggers, such as stress, certain foods, or poor sleep, may make you more susceptible to headaches, but they aren’t the underlying causes of migraines.
“Perimenopause often provides challenges in the treatment of migraine because of loss of predictability of hormone-related attacks and frequent worsening of symptoms. The fluctuation in estrogen levels in perimenopause may cause hormone headaches to increase,” said Dr. Shae Datta the co-director of NYU Langone’s Concussion Center and director of cognitive neurology at NYU Langone Hospital-Long Island.
“Specific SNRI [drugs] can be used to target the vasomotor symptoms and sleep disruptions that occur during menopause and double to treat migraine severity and intensity,” she told Healthline.
There are also some lifestyle changes that can be made to help reduce the intensity or frequency of headaches.
Dimitriu suggests the following lifestyle changes:
- Maintain regular sleep patterns. Go to sleep and wake up at the same time each day. Maintain sleep hygiene. For example, institute routines that promote rest and make your bedroom comfortable and free of disruptions. If you nap, keep it short and limit naps to the early afternoon.
- Exercise regularly. In particular, aerobic exercises, walking, stretching, and swimming can eliminate stress and anxiety and make sleeping easier at night.
- Eat regular meals. Do not skip meals, eat a good, healthy breakfast, and avoid food high in carbs. Limit eating in the hours leading up to your bedtime to light snacks. Eating a big, heavy, or spicy meal late in the day means you could still be working to digest it when trying to sleep.
- Reduce stress. In addition to regular exercise, use stress-reducing strategies such as yoga, meditation, and deep breathing techniques.
- Avoid known triggers such as certain foods, wines, cheeses, and others that trigger a migraine.
Getting a good night’s sleep may not eliminate headaches, but it can help to reduce the frequency and intensity, experts say.
Good sleep hygiene isn’t the same for everyone; it can differ based on the person. To find what works best for you, experts say experiment with sleep adjustments and start with minor changes.
If changes in sleep hygiene don’t work, it might be beneficial to talk with a sleep specialist. Frequent insomnia, sleep apnea, and other sleep disorders may require treatment. And while there wasn’t a definite link between sleep apnea and migraine, not sleeping can be a trigger for migraine and regular, adequate sleep leads to fewer headaches, according to the American Migraine Foundation.
“Women should also be instructed to keep a headache diary, and both preventative and acute treatment options should be considered based on headache frequency and burden,” said Datta. “Treatment of other comorbidities like BMI, hypertension, mood issues, and sleep quality should guide the choice of medications.”
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