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Review
. 2025 Jun;14(3):665-680.
doi: 10.1007/s40120-025-00720-2. Epub 2025 Mar 14.

Menopause, Perimenopause, and Migraine: Understanding the Intersections and Implications for Treatment

Marta Waliszewska-Prosół  1 , Giovanni Grandi  2 , Raffaele Ornello  3 , Bianca Raffaelli  4   5 , Marcin Straburzyński  6 , Claudio Tana  7 , Paolo Martelletti  8
Affiliations
Review

Menopause, Perimenopause, and Migraine: Understanding the Intersections and Implications for Treatment

Marta Waliszewska-Prosół et al. Neurol Ther. 2025 Jun.

Abstract

Migraine affects women three times more often than it does men, and various mechanisms may explain this incidence, including the key role of female sex hormones. Fluctuations in the levels of these hormones and their feedback control regulate the menstrual cycle, pregnancy, puerperium, perimenopause, and menopause. They can influence the occurrence and severity of migraine throughout the reproductive period. Of particular importance seems to be the perimenopausal period, which is associated with an increase in migraine, especially menstrual migraine, which is considered more disabling and less amenable to treatment than non-menstrual attacks. This article reviews the available evidence documenting the relationship between perimenopause, menopause, and migraine and diagnostic considerations in an attempt to determine the management of these periods of a woman's life. Special considerations, future directions, and unmet needs for perimenopausal and menopausal migraine are also discussed.

Keywords: Perimenopause; Estrogen; Menopause; Migraine; Progesterone.

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Conflict of interest statement

Declarations. Conflict of Interest: Marta Waliszewska-Prosół is a member of the Editorial Board of The Journal of Headache and Pain; reports personal fees from AbbVie, Pfizer, Polpharma and Teva for speaker activities. Giovanni Grandi received honoraria for sponsored lectures and participation in advisory boards from Organon, Bayer AG, Teva/Theramex, Exeltis, Italfarmaco, Opocrin and Gedeon Richter outside of the scope of this manuscript. Raffaele Ornello reports personal fees and non-financial support from AbbVie, Eli Lilly, Lundbeck, Novartis, Pfizer, and Teva; received research grants from Novartis; is Associate Editor for the Headache and Neurogenic Section of Frontiers in Neurology and for Arquivos de Neuropsiquiatria; is a Junior Editorial Board Member of The Journal of Headache and Pain; is an Editorial Board Member of Confinia Cephalalgica. Bianca Raffaelli is a member of the Editorial Board of The Journal of Headache and Pain; reports personal fees from AbbVie, Eli Lilly, Lundbeck, Novartis, Organon, Perfood and Teva for participating in advisory boards and/or speaker activities as well as research funding from Lundbeck, Novartis, Else Kröner-Fresenius-Stiftung, German Research Foundation and German Migraine and Headache Society. Marcin Straburzyński reports personal fees from Pfizer, Teva, Bausch, AbbVie, Neuca and Novartis for speaker activities. Claudio Tana is a member of the Editorial Board of The Journal of Headache and Pain and Editor of the Primary Care Section of Annals of Medicine. Paolo Martelletti is the Editor-in-Chief of The Journal of Headache and Pain and of SN Comprehensive Clinical Medicine. Paolo Martelletti and Raffaele Ornello are Editorial Board members of Neurology and Therapy. Paolo Martelletti and Raffaele Ornello were not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Menstrual cycle rhythmicity
Fig. 2
Fig. 2
Acute and preventive treatment options for perimenopausal women with migraine
See this image and copyright information in PMC

References

    1. Ripa P, Ornello R, Degan D, Tiseo C, Stewart J, Pistoia F, Carolei A, Sacco S. Migraine in menopausal women: a systematic review. Int J Womens Health. 2015;20(7):773–82. - PMC - PubMed
    1. te Velde ER, Pearson PL. The variability of female reproductive ageing. Hum Reprod Update. 2002;8(2):141–54. - PubMed
    1. Cupini LM, Matteis M, Troisi E, Calabresi P, Bernardi G, Silvestrini M. Sex-hormone-related events in migrainous females. A clinical comparative study between migraine with aura and migraine without aura. Cephalalgia. 1995;15(2):140–4. - PubMed
    1. Grangeon L, Lange KS, Waliszewska-Prosół M, et al. Genetics of migraine: where are we now? J Headache Pain. 2023;24(1):12. - PMC - PubMed
    1. Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RB. Perimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache. 2016;56(2):292–305. - PubMed

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