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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache

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Perimenopausal migraine: a narrative review.

Salwa Kamourieh¹, E Anne MacGregor^2,3

¹Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK.

Climacteric : the Journal of the International Menopause Society

|June 11, 2026

Summary

Hormone therapy impacts migraine frequency and severity in women, especially during perimenopause and postmenopause. Hormone cycle control is recommended during perimenopause, while continuous transdermal regimens are preferred for postmenopausal hormone therapy.

Keywords:

Migraine contraception menopause hormone therapy menopause transition menstrual migraine perimenopause postmenopause

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Area of Science:

Neurology
Endocrinology
Women's Health

Background:

Migraine is a prevalent headache disorder significantly influenced by female sex hormones, particularly estrogen.
Perimenopausal hyperestrogenism and anovulatory cycles correlate with increased migraine frequency, severity, and perimenstrual migraine.
Menopause typically improves migraine, but this varies and can be complicated by chronic migraine, menopausal symptoms, and hormone therapy use.

Purpose of the Study:

To review the impact of estrogen fluctuations and hormone therapy on migraine during perimenopause and postmenopause.
To discuss appropriate hormonal management strategies for migraine sufferers in these life stages.

Main Methods:

Literature review and synthesis of existing research on migraine, sex hormones, perimenopause, menopause, and hormone therapy.
Analysis of clinical effects of different hormonal interventions on migraine patterns.

Main Results:

Hyperestrogenism during perimenopause exacerbates migraine; menopause often improves it, but not universally.
Menopause hormone therapy (MHT) use during perimenopause may negatively affect migraine, possibly due to high, fluctuating estrogen levels.
Continuous combined hormonal contraception is suitable for migraine without aura; progestogen-only regimens with optional transdermal estrogen suit migraine with or without aura during perimenopause.

Conclusions:

Hormone cycle control is a more appropriate strategy than MHT during perimenopause for managing migraine.
For postmenopausal women using MHT, continuous transdermal regimens are better tolerated and potentially better for migraine management than cyclical preparations.