Does Migraine Go Away After Menopause? What a 315-Woman Study Found
In a clinic study of 315 women with migraine before menopause, 219 still had attacks afterward, though fewer and milder. A family history of migraine and insomnia were linked to migraine continuing.
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Why This Study Was Done
Women with migraine are often told that their attacks will stop once they reach menopause. Migraine does improve after menopause for many women, but a sizable share keep having migraine attacks.
Earlier research has been mixed. A systematic review found that studies of the general population tend to show migraine improving after menopause, with a possible rise during perimenopause, the years leading up to the final period. Studies of women treated at headache clinics have shown little improvement or even worsening. The same review found that improvement was more likely after natural menopause than after surgical menopause. Our article on migraine, menopause, and hormonal health covers these hormonal changes in more depth.
A study published on November 3, 2026 in the journal Headache asked two questions in women seen at headache clinics in Egypt. Which women keep having migraine after menopause, and how does migraine change when it continues?
How the Study Was Done
This was a retrospective cohort study at five headache clinics in Egypt, carried out between September 2025 and March 2026. The researchers searched clinic records for women with a migraine diagnosis who were born between 1971 and 1978, which put them in their late 40s to mid 50s at the time of the study. These women were invited to a face-to-face interview.
Each woman was placed in one of two groups.
- Persistent migraine. She still had migraine after menopause.
- Resolved migraine. She no longer had migraine after menopause.
Pain severity, rated on a 0 to 10 visual scale, and monthly migraine days from before menopause were taken from the clinics' records. The researchers compared these with the same measures after menopause, assessed during the study.
Menopausal symptoms such as hot flashes, sleep problems, and mood changes were scored with the Menopause Rating Scale, a standard questionnaire.
Who Took Part
All of these women were patients at specialist headache clinics, where migraine tends to be more severe or harder to treat than in the general population. For that reason, the split of 219 to 96 does not tell us how often migraine continues after menopause for women in general. The authors note that the clinic-based sample limits how far the results apply.
How Migraine Changed When It Continued
Among the 219 women whose migraine continued, migraine was milder after menopause on each measure the researchers compared. The numbers below are medians, the middle value for the group.
| Measure | Before menopause | After menopause |
|---|---|---|
| Pain severity (0 to 10) | 7 | 6 |
| Monthly migraine days | 8 | 6 |
| Women reporting aura | 134 of 219 (61%) | 116 of 219 (53%) |
All three changes were statistically significant.
A drop from 8 to 6 migraine days a month is a modest change. Women whose migraine continued still had regular migraine attacks, and a quarter of them had 10 or more migraine days a month after menopause. These women still need effective acute and preventive treatment.
Fewer women reported aura after menopause, although more than half still did. Aura is its own phase of a migraine attack, most often visual changes such as zigzag lines or blind spots that develop over several minutes. Migraine with aura is linked to a higher risk of ischemic stroke, and cardiovascular risk rises in midlife. Our article on migraine and stroke risk after menopause covers what a 130,000-woman study found.
What Was Linked to Migraine Continuing
The researchers compared the two groups to see which factors were tied to migraine continuing after menopause. Three factors remained linked after the analysis accounted for the other factors at the same time.
An odds ratio of 1.92 for family history means that women with a parent, sibling, or child with migraine had roughly twice the odds of their migraine continuing compared with women without that family history. Insomnia was tied to a similar increase, with an odds ratio of 2.22.
Family history
Migraine runs in families, and a first-degree relative with migraine points to a stronger inherited tendency toward the condition. In this study, that tendency was linked to migraine continuing even after the hormonal changes of menopause.
Insomnia
Sleep problems are common in midlife and around menopause, along with hot flashes and mood changes. Sleep and migraine affect each other in both directions, so this study cannot say whether insomnia keeps migraine going or migraine disrupts sleep. Our article on how sleep and migraine affect each other explains that two-way relationship.
Insomnia is treatable either way. The American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as the first treatment for chronic insomnia in adults.
Surgical menopause
Surgical menopause usually means both ovaries are removed, which drops hormone levels suddenly instead of over several years. The odds ratio of 4.00 looks large, but its 95% confidence interval ran from 1.29 to 12.41. A range that wide means the true effect could be anywhere from small to very large. The authors note that few women in the study had surgical menopause and advise reading this result with caution. It is in line with earlier research showing that migraine is less likely to improve after surgical menopause than after natural menopause.
This was an observational study, so these factors are associations. Having a family history or insomnia does not mean migraine will continue, and not having them does not mean it will stop.
Why Hormones Play a Role
Estrogen affects how the trigeminovascular system, the network of nerves and blood vessels involved in migraine pain, handles pain signals. The drop in estrogen just before a period is widely thought to trigger menstrual migraine attacks, although a 2023 review found that the evidence for this idea is less complete than often assumed. Our article on menstrual migraine explains the estrogen connection.
During perimenopause, estrogen and progesterone levels rise and fall unpredictably, and migraine attacks can become more frequent and harder to predict. After menopause, hormone levels stay low and steady. Because shifting hormone levels are thought to drive many attacks, this steadiness is one proposed reason that migraine without aura often improves after menopause, while migraine with aura is more likely to continue.
For how migraine tends to change from puberty through pregnancy and menopause, see migraine through a woman's life.
Treatment Around and After Menopause
This study did not test treatments. A 2026 review in Headache by neurologists at Mass General Brigham summarized how migraine care can be adjusted during and after the menopausal transition.
| Treatment area | What the review says |
|---|---|
| Migraine prevention | Should follow established, evidence-based migraine preventives. |
| Menopausal hormone therapy | Effects on migraine vary. Oral estrogen, especially at higher doses, may worsen migraine and raise vascular risk, particularly in women with aura. Low-dose estrogen delivered through the skin, such as a patch or gel, appears safer and better tolerated. Continuous progestogen regimens may cause fewer withdrawal-related attacks than cyclic ones. |
| Hot flashes alongside migraine | Nonhormonal options may be considered, such as antidepressants in the SNRI class, for example venlafaxine (Effexor). |
| Standard migraine treatments | Triptans, NSAIDs, beta-blockers such as propranolol (Inderal), topiramate (Topamax), and antidepressants such as amitriptyline (Elavil) remain central but need to be tailored to vascular, bone, and metabolic health. |
| Newer drugs that do not narrow blood vessels | CGRP antibodies such as erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti), gepants such as rimegepant (Nurtec ODT), ubrogepant (Ubrelvy), and atogepant (Qulipta), and lasmiditan (Reyvow) offer options for women with cardiovascular reasons to avoid triptans. |
For a full look at which preventive treatments have the strongest evidence, see our summary of the AAN and AHS migraine prevention guideline.
If migraine is continuing or changing around menopause, a written record of attack frequency, aura, sleep, and menopausal symptoms can make an appointment more productive. The free migraine appointment summary sheet can help you put that together.
Common Questions This Study Helps Answer
Will my migraine stop after menopause?
It may improve, especially after natural menopause, but it does not stop for everyone. In this group of women seen at headache clinics, 219 of 315 still had migraine after menopause, although their attacks were usually less frequent and less painful.
Does a family history of migraine mean mine will continue?
Not necessarily. A family history roughly doubled the odds of migraine continuing in this study, but it does not decide the outcome for any one person.
I had my ovaries removed. Will my migraine continue?
This study and earlier research suggest migraine is less likely to improve after surgical menopause, but the estimate here was based on few women and was imprecise. If your migraine changed after surgery, bring it up with your clinician so your treatment plan, including any hormone therapy, can be reviewed.
Can treating insomnia help migraine after menopause?
This study did not test that. It found a link between insomnia and migraine continuing, not proof that one causes the other. Insomnia is treatable in its own right, and CBT-I is the recommended first treatment for chronic insomnia in adults.
Is hormone therapy safe if I have migraine?
It depends on the type of hormone, the dose, how it is taken, and whether you have migraine with aura. The 2026 review notes that low-dose estrogen through the skin appears safer than higher-dose oral estrogen, especially for women with aura. This is a decision to make with your clinician.
Limitations to Keep in Mind
- Clinic-based sample. All of the women came from headache clinics, so the results may not reflect women with milder migraine in the general population.
- Looking back in time. The before-menopause numbers came from clinic records and the after-menopause numbers came from the study assessment, so the two were not collected in the same way.
- One country. All participants were Egyptian women, and results may differ in other populations.
- Small subgroup. Few women had surgical menopause, which made that estimate imprecise.
- Associations only. As an observational study, it can show links but not causes.
- Age range. Participants were in their late 40s to mid 50s, so the study cannot show how migraine changes over the following decades.
Key Takeaways
- Of 315 women with migraine before menopause, seen at five headache clinics in Egypt, 219 still had migraine after menopause and 96 did not.
- When migraine continued, it was usually milder, with median monthly migraine days falling from 8 to 6 and median pain scores falling from 7 to 6 out of 10.
- A first-degree relative with migraine and insomnia were each linked to about twice the odds of migraine continuing.
- Surgical menopause showed a stronger link, but the estimate was imprecise because few women had it.
- Because the women came from headache clinics, the study does not show how often migraine continues after menopause in the general population.
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Decisions about hormone therapy and migraine treatment should be made with a healthcare provider. A headache that is new, different from your usual migraine attacks, or that starts after age 50 should be checked by a healthcare provider.
References
- Hassan A, Hussein M, Elmazny A, et al. Factors associated with postmenopausal migraine persistence: A retrospective tertiary headache clinic-based study. Headache. Published online November 3, 2026. doi:10.1111/head.70240.
- Ripa P, Ornello R, Degan D, et al. Migraine in menopausal women: a systematic review. International Journal of Women's Health. 2015;7:773-782. doi:10.2147/IJWH.S70073.
- Raffaelli B, Do TP, Chaudhry BA, et al. Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence. The Journal of Headache and Pain. 2023;24(1):131. doi:10.1186/s10194-023-01664-4.
- Korn TF, Bernstein C. Migraine across the menopausal transition and beyond: A narrative review. Headache. 2026;66(6):1390-1404. doi:10.1111/head.70071.
- Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2016;165(2):125-133. doi:10.7326/M15-2175.
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