Perimenopause Headaches vs. Regular Headaches: What’s the Difference?

3 minute read

By: Alloy Staff|Last updated: March 4, 2024|Medically reviewed by: Sharon Malone
Woman wearing blazer sitting at desk with cup of coffee rubbing her forehead. AW483

Nearly everyone suffers from the occasional headache. We’ve all experienced the dull pain behind our eyes, or the throbbing in our temples. But you may have noticed that all headaches are not the same. Headaches vary both by type and by cause. 

Tension headaches, or regular headaches, are the most common type and occur in about 75% of the general population. Tension headaches are typically experienced as a generalized band of pressure or vice-like sensation that runs across your entire forehead, around your head, or down your neck. Tension headaches can last from 30 minutes to several days, are usually mild but, in rare cases, can be debilitating. Unlike other headaches, they are not associated with nausea or vomiting. Brought on by stress, fatigue, excessive alcohol or caffeine use, and eyestrain, tension headaches are most prevalent in your 30s and decline in frequency thereafter.  

Along with tension headaches, women also suffer from hormone-related headaches. Of the 12% of Americans who suffer from migraines, the majority of them are women, and 60% of those women report noticing a correlation between their headache symptoms and their menstrual cycles. The fluctuations in hormones that accompany menopause can bring on perimenopause headaches, also known as perimenopause migraines. Perimenopause headaches cause throbbing pain, typically localized to one side of the head, and can drive you to seek out a dark and quiet spot, maybe under the covers in your bed.

If you’re dealing with menopause symptoms, including perimenopause headaches, Alloy can help. Simply fill out our online assessment and an experienced doctor will review your responses and recommend the menopause hormone therapy that will work best for you.

Can Perimenopause Cause Headaches?

It’s completely normal to have more frequent headaches during perimenopause—the transitional time before your periods fully stop and you enter menopause. Estrogen and progesterone both help regulate systems throughout the body, including the brain chemicals responsible for headaches. During perimenopause, estrogen and progesterone levels fluctuate, slowly decreasing over time. These uneven levels of hormones can trigger menopause headaches.

While it is true that some women (24%) with a history of migraine headaches report an improvement in their symptoms as they complete menopause, 37% of them report worsening headaches during perimenopause. Furthermore, you do not have to have a history of migraines to develop them in perimenopause. Perimenopause can actually trigger your first-ever migraine! Overall, 10-29% of menopausal women complain of migraine headaches and research has shown that hormones play a major role.

What Do Perimenopause Headaches Feel Like?

Perimenopause headaches typically present as a throbbing pain on one side of your head. You may also experience sensitivity to light and sound. The good news is that these headaches are not usually debilitating and can be well controlled with treatment.

How Long Do Perimenopause Headaches Last?

Most perimenopause headaches will last for a few hours; in extreme cases, however, they can span several days. If you have suffered from a severe headache that does not respond to treatment and has lasted for more than one day, seek the help of a medical professional, as it may indicate a more severe condition than hormone imbalance. 

Types of Perimenopausal Migraines

One way in which migraine headaches, including menopausal migraines, may be categorized is whether they’re accompanied by an aura. 

Migraines with Aura

Migraine aura symptoms can include visual changes, such as “floaters,” flashing lights, and photosensitivity. Nausea and auditory sensitivity may also accompany migraines. These auras typically occur about an hour before any head pain commences. In this way, the aura may act as your body’s warning signal for what is about to happen.

Migraines Without Aura

Migraines without prodromal, or early, auras are more common. It is possible for you to experience both types of migraines at different times. 

Migraines vs. Tension Headaches

Regardless of the type of headache you have, you just want it to stop. You probably haven’t been parsing your symptoms trying to distinguish between perimenopause headaches or perimenopause migraines and tension headaches. That said, knowing whether you are suffering from perimenopause migraines or “regular” tension headaches is important and will determine how to best treat your symptoms.

Migraine Symptoms

Migraine symptoms are distinctive and can involve parts of your body beyond your head.

  • Intense Throbbing

The main symptom of a perimenopause migraine is, unsurprisingly, pain. This pain is typically an intense throbbing that may have started as a dull ache on one side of your head. It usually starts mild but, if left untreated, progresses to moderate or severe. The pain can shift from one side of the head to the other and can localize to the forehead or back of the neck. 

  • Nausea

Nausea is a common symptom of perimenopause migraines. For some women this nausea is mild, making them feel queasy and resulting in a loss of appetite. For others it is a more intense sensation, filling them with the sense that they will imminently vomit.

  • Vomiting

Along with causing nausea, your perimenopause migraine, if left untreated, may lead you to actually vomit. Frequent vomiting can lead to dehydration, so you will want to increase your fluid intake should this happen. If you experience uncontrolled vomiting, however, you should seek immediate medical care.

  • Sensitivity to Sound, Light, or Smells

Are your headaches causing you to shy away from light, making you want to cover your ears, or compelling you to hold your nose? If so, know that this is normal. During a perimenopause migraine your senses of sight, hearing, and smell can all be temporarily affected. Many migraine sufferers seek out a dark and quiet spot as they are recovering from their headaches.

  • Visual Disturbances

Along with photosensitivity, perimenopause migraines can bring on other visual disturbances. You may experience blurred vision, trouble focusing, and/or watery eyes. Again, these changes are temporary and will abate once your headache subsides.

Tension Headache Symptoms

Tension headaches are the most common type and are often referred to as “regular” headaches. Tension headache symptoms are usually confined to the head and neck region, unlike the more far-reaching consequences of a perimenopause migraine.

  • Dull Aching

A tension headache is often described as a slowly progressing, dull aching sensation that encompasses the whole head. The ache is typically mild to moderate and is felt on the top, sides, and front of your neck.

  • Tightness and Pressure on Forehead or Temples 

Along with the dull aching, during a tension headache you may experience a vice-like tightness or pressure sensation across your forehead and around your temples. 

  • Scalp, Neck, and Shoulder Tenderness

Tension headache symptoms can spread and cause tenderness of the scalp, neck, and shoulder. You may feel very sensitive to touch in any of these areas.

How to Treat Perimenopause Migraines

Perimenopause migraines can range from being mild to intense and debilitating. The good news is that there are several things you can do to treat them and take back control of your health and wellness.

Start or Adjust Menopause Hormone Therapy

As you now know, perimenopausal headaches can be triggered directly by your body’s fluctuating hormone levels. Stabilizing your estrogen levels through safe and effective  hormone therapy can be helpful for women who have a clearly identifiable link to their periods.  Perimenopausal headaches are usually worse the week prior to the menstrual period.  The trigger for these headaches is the abrupt drop in estrogen levels.  This can be addressed by adding supplemental estrogen the week before the period is due or for those with irregular periods, continuous use of oral contraceptives (simply skipping the placebos).

For some women, perimenopausal migraines are actually triggered by other menopausal symptoms; for example, hot flashes and night sweats lead to disturbed sleep, and the lack of sleep can make migraines more likely. MHT has been found to be safe and effective in the majority of healthy women in the treatment of myriad menopausal symptoms including these migraine triggers. If you start MHT and find that your migraines actually worsen, it is likely that your dosage needs to be adjusted and this side effect should be temporary.

Maintain a Healthy and Balanced Diet 

If you are suffering from perimenopause headaches, understanding the role your diet plays can be a powerful tool in preventing them. Try to eat at regular times each day and avoid foods and drinks that may be potential migraine triggers, such as alcohol, chocolate, pickles, and caffeinated beverages. 

Keep a Food Journal to Monitor Potential Triggers

Keeping a food journal can help you to identify your perimenopausal headache triggers. Be sure to keep track of what and when you eat and how quickly thereafter you develop a migraine. 

Relaxation Techniques/Meditation

Reducing stress will help to keep your perimenopausal migraines to a minimum. Using relaxation techniques including breathing exercises and meditation can help you to feel more balanced and have been shown to reduce migraine frequency. These tactics also have a positive impact on how you perceive migraine pain and can reduce the need for analgesic medications during migraine episodes.

Exercise Regularly

Research suggests that regular exercise can help prevent migraines from occurring. Exercise triggers the release of endorphins, the body’s natural pain killers. Additionally, regular physical activity decreases stress and improves sleep, which will help you succeed in combating perimenopause headaches. You likely will not feel like exercising during a menstrual headache, which is understandable. When you feel well, try and maintain a regular program of physical activities you enjoy. 

Get Enough Sleep

Good sleep hygiene is important for a number of reasons, including headache prevention. Maintaining a regular sleep schedule, avoiding late-night screen scrolling, minimizing daytime napping, and keeping your bedroom at a comfortable temperature are all part of a healthy sleep routine. You should aim to get 7 -8 hours of restful sleep a night.

Stay Hydrated

Dehydration is closely associated with increased severity and frequency of migraine headaches. Research has shown that staying hydrated reduces the number, severity, and duration of migraines. Aim to drink 8-10 8 ounce glasses of water every day. You can also boost your water intake by eating fruits and vegetables with high water contents, including watermelon, honeydew, cantaloupe, broccoli, lettuce, celery, and tomatoes.

Alloy Can Help You Manage Menopause Symptoms

If you are suffering from symptoms like perimenopause headaches, know that you are not alone. Alloy can help. Start today with an online evaluation and get connected to a menopause-trained doctor who can analyze your symptoms and get you the treatment you need.


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