Before puberty, boys get migraines more often than girls. That flips fast. Once a girl has her first period, her risk climbs sharply. It keeps rising through her teens, twenties, and thirties, and peaks in her mid-forties. For decades, brain and headache experts have asked one simple question: why?
The answer has more to do with hormones than with the brain itself. Migraines affect women at different stages of life. How often they happen and how bad they get depends on changes in hormones from the ovaries. Three times more women experience migraine than men, and an estimated 37 million Americans live with the condition. Even though migraines are common and can be disabling, they are still often brushed off, undertreated, or mistaken for normal headaches.
Is a migraine just a bad headache?
A migraine is very different from a headache. Treating it like one is a big reason so many women stay in pain longer than they need to. Hormone changes play a key role in migraines in women. Migraines become more common at puberty and less common after menopause. That points to sex hormones as part of the cause, and estrogen seems to matter most.
A migraine happens in stages, and not all of them include head pain. The prodrome phase can begin 24 to 48 hours before other phases. This early warning stage can bring crankiness, a stiff neck, food cravings, and sensitivity to light. Most people don’t link these signs to a coming migraine. Some women also get an aura at this point. An aura is a change in vision, like flashing lights or blind spots, that means the headache is close.
A migraine headache lasts between four hours and 72 hours. The attack stage brings severe head pain and nausea. Light and sound can be hard to bear. After the pain clears, many people go through a “postdrome.” They feel foggy, worn out, and low for up to two days. The World Health Organization ranks migraine among the top 10 most disabling illnesses in the world. With all four stages added up, one migraine can take up most of a week.
Why are women more vulnerable to migraine?
Before puberty, boys get more migraines. After puberty, girls do. That switch lines up almost exactly with a girl’s first period. The likelihood of migraines increases when girls begin menstruating.
Scientists now understand the link between hormones and migraines better than they did 10 years ago. Sex hormones affect the nerve pathways involved in migraines. This helps explain why women get more migraines and why the pattern changes over their lives. Estrogen seems to make the brain more sensitive to the inflammation proteins that set off an attack. Estrogen also raises levels of nitric oxide. Nitric oxide widens blood vessels and can cause swelling around nerves, which may make women more likely to get migraines.
Up to 70 percent of women with migraines report a connection between their attacks and their periods. These “menstrual migraines” tend to last longer and are harder to treat than migraines at other times. That’s because they happen when estrogen drops sharply in the days just before a period starts. Increased susceptibility to migraine during menstruation and in perimenopause is probably due to fluctuations in estrogen.
Read More: How Does Exercise Affect Your Hormones? What Women Should Know
Pregnancy gives another clue. Migraines often get better during pregnancy, especially in the second and third trimesters, because estrogen stays high and steady. According to the Migraine Trust, many women’s migraines improve by the end of pregnancy. But women who get migraines with aura are more likely to get worse. On the other hand, combined birth control pills change the estrogen cycle. Women who take them often find their migraines get worse, especially if they have migraines with aura.
Women who get migraines with aura should talk to a doctor about birth control. The research on stroke risk from combined hormone birth control in this group is mixed. Older studies suggest a higher risk of stroke caused by a blood clot. Newer real-world studies find the actual risk is still low and about the same as with progestin-only birth control. Have this talk with your doctor before you start or keep using this type of birth control.
The Perimenopause Surge
The second peak in migraines usually comes in a woman’s forties, during perimenopause. That’s the few years before her last period. Migraines often get worse and happen more often during this time. The reason is the same as with periods: estrogen levels jump around. In perimenopause, estrogen doesn’t just drop. It swings up and down without warning, and those swings often trigger migraines. The Menopause Society estimates that 10 to 29 percent of women get migraines during the change to menopause.
After menopause, things often get better. According to the American Migraine Foundation, many women find their migraines ease or stop completely after menopause. That’s because hormone levels become steady. Without the ups and downs, it takes more to trigger an attack.
Whether to use hormone therapy during and after menopause is a hard choice. A review of many studies was presented at the 2026 Annual Meeting of The Menopause Society. It found that women past menopause who used hormone therapy had migraines more often, and their migraines lasted longer. But the migraines were not more painful. Stephanie Faubion, MD, MBA, is medical director of The Menopause Society. She said hormone therapy is still the best treatment for hot flashes and night sweats and “can be used safely in many women with migraine.” For women in this spot, the advice is to use the lowest estrogen dose that works. Patches or gels may also help, since they give steadier levels than pills.
Women Get More Severe Attacks
Women are more likely than men to have moderate to severe pain. Their migraines also tend to last longer and feel more intense. They’re more likely to have nausea, vomiting, and light sensitivity, which make it hardest to get through the day. This is very likely due to the hormone effects described above. It also affects treatment. A dose of medicine that stops a migraine in a man may not be enough for a woman having a menstrual migraine when her estrogen is at its lowest.
Treatment: What’s Actually Working
To stop a migraine once it starts, triptans are still one of the best types of drugs. They narrow blood vessels and block pain signals in the brain. Women with frequent menstrual migraines do much better when they take a triptan as soon as the attack starts, instead of waiting for the pain to build. A mix of medicine and lifestyle changes can help make hormone-related migraines less severe and less frequent.
Prevention has changed a lot. In 2024, the American Headache Society said drugs that target CGRP should be a first choice for preventing migraines. Patients no longer have to try other drugs first. The older 2021 advice made patients fail at least two other types of prevention pills before they could get CGRP drugs. CGRP is a protein that can make migraines worse. CGRP drugs were the first made to treat and prevent migraines directly. They block or remove extra CGRP. CGRP levels seem to be affected by hormones. Researchers are still studying whether these drugs work especially well for women with period-linked migraines.
There are four approved CGRP antibody drugs. They are erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti). All are given as shots or through an IV. There are also pills in the same family, called gepants. CGRP-targeted therapies can cut how often migraines happen. They can make the ones that do happen shorter and milder, and stop some completely.
For people with 15 or more headache days a month, Botox is a proven option. Botox (onabotulinumtoxinA) received FDA approval in 2010 to prevent chronic migraine. The shots go into the scalp, neck, and upper back every 12 weeks. Where the needles go, the doses, and the nerves targeted are all different from cosmetic Botox.
Non-Drug Options Are Getting More Serious
Some women would rather not add more drugs on top of their hormone changes. Drug-free treatments have gotten much better. One of the best studied is called Remote Electrical Neuromodulation, or REN. It comes in a prescription wearable device called Nerivio. The FDA has cleared it to treat migraines as they happen and to help prevent them. It has been studied in both adults and children. It sends mild signals to nerves in the upper arm. This turns on the brain’s own pain-blocking system to stop the attack.
A 2024 study in Advances in Therapy looked at how safe and effective REN was over 12 months of use. Earlier studies had already shown it was safe and worked for treating migraines as they happen. A separate 2026 study by Nahas et al. in Headache followed people for three years. REN kept working just as well over that time.
Lifestyle habits also matter. Regular sleep, regular meals, aerobic exercise, and drinking enough water all help cut down on attacks by keeping the brain steady. Women can also keep a diary of their migraines and their periods. It shows patterns and gives doctors what they need to choose the right treatment.
What can you do now?
A 25-year-old with menstrual migraines, a 44-year-old in perimenopause, and a 55-year-old who just reached menopause all have different hormone patterns. They may respond very differently to the same treatment. During perimenopause, uneven hormone swings can make migraines more frequent and severe. Most women get better once they reach menopause, according to the American Migraine Foundation. Because of these differences, one treatment plan rarely works for every woman.
If you have more than four migraine days a month, or your attacks keep lining up with your period, ask your doctor about prevention. Don’t settle for pain relief alone. CGRP drugs are now a first choice, so you don’t have to try older drugs first. If your migraines cluster around your period, bring a diary of your symptoms and cycle to your visit. It gives your doctor the clearest picture of what’s causing your migraines and which treatment may work best.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.