Why Perimenopause Could Be Making Your Migraines Worse – and What You Can Do About It

October is Menopause Awareness Month, and this year's theme for World Menopause Day on 18 October is Chronic Pain at Midlife. While we often associate perimenopause with hot flushes, night sweats and mood changes, pain is another symptom that can have a significant impact on women's quality of life – and migraines are a particularly

debilitating example.

If you've noticed that your migraines are becoming more frequent, more intense or are appearing at certain points in your menstrual cycle, fluctuating hormones could be playing a role. For women who have experienced migraines for years, perimenopause can sometimes make them worse. Others may experience migraines for the first time during this stage of life. Migraines can be debilitating, affecting everything from work and family life to sleep, exercise and social activities. For some women, frequent migraines can become a chronic condition, yet many don't realise just how closely their migraines may be connected to their changing hormones.

Migraines are something I have personal experience of, and I know just how debilitating they can be. I've also experienced how hormonal changes during perimenopause can influence their frequency and severity. It's a subject particularly close to my heart, both personally and professionally, and one of the reasons I'm so interested in exploring how nutrition and lifestyle may help reduce the factors that contribute to migraines.

But why does this happen, and can nutrition and lifestyle changes help?

The Connection Between Oestrogen and Perimenopause Migraines

One of the main hormonal triggers for migraines is a sudden drop in oestrogen, often referred to as oestrogen withdrawal. Oestrogen doesn't just regulate our menstrual cycles, it also influences several processes in the brain, including serotonin activity, pain signalling and the way our nervous system responds to stimuli. Serotonin is a neurotransmitter involved in mood regulation, sleep and pain processing, and changes in serotonin signalling are thought to play a role in migraine.

During our reproductive years, oestrogen naturally rises and falls throughout the menstrual cycle. Migraines are particularly common during ovulation, in the days leading up to menstruation and during the first few days of a period, when oestrogen levels fall. During perimenopause, however, hormone levels can become much more unpredictable. As ovulation becomes less regular, oestrogen can fluctuate dramatically, sometimes reaching higher levels than usual before dropping sharply. These fluctuations may make the brain more susceptible to migraines.

Interestingly, it's often the sudden change in oestrogen, rather than simply having low oestrogen, that triggers a migraine. This helps explain why some women experience worsening migraines during perimenopause but find that their symptoms improve after menopause, when hormone levels become more stable.

Progesterone levels also change during perimenopause, particularly as ovulation becomes less consistent. Although the relationship between progesterone and migraines is less clearly understood than that of oestrogen, these hormonal changes can also affect sleep and other symptoms that influence migraine susceptibility.

Understanding Your Migraine Threshold – The Bucket Analogy

One of the most helpful ways to understand migraines is to imagine that we all have a bucket. Throughout the day, different factors add water to that bucket, gradually filling it up. For someone prone to migraines, these might include fluctuating oestrogen levels, a poor night's sleep, stress, dehydration, skipping meals, drinking too much coffee or eating a food that they're particularly sensitive to. Each of these factors adds a little more water to the bucket. Individually, they might not be enough to trigger a migraine, but when several occur together, the bucket eventually overflows – and a migraine occurs. This is sometimes referred to as the migraine threshold theory.

During perimenopause, hormonal fluctuations may mean your bucket is already partly full before the day has even begun. Add a restless night, a stressful morning and a missed meal, and suddenly you may find yourself experiencing a migraine that seemingly came out of nowhere.

The important thing to understand is that we can't always control every factor that contributes to migraines, particularly our changing hormones. However, by identifying and addressing some of the other factors filling our bucket, we may be able to reduce the likelihood of reaching that migraine threshold. This is where nutrition and lifestyle changes can play a valuable role.

Could Histamine Be Contributing to Your Migraines?

Histamine is a naturally occurring chemical involved in immune responses, digestion and communication within the nervous system. It can also influence blood vessels and pain-signalling pathways, which has led researchers to investigate its possible role in migraines. Some people find that foods containing histamine or other naturally occurring compounds, such as tyramine, appear to trigger their migraines. These include red wine, beer, aged cheeses, fermented foods, cured and processed meats, and certain fish.

Interestingly, there may also be a connection between histamine and our changing hormones. Oestrogen can influence histamine signalling and high oestrogen levels, often found in perimenopause, can cause more histamine to be released. High histamine can also cause more oestrogen to be released, and you find yourself in a vicious cycle with both oestrogen and histamine levels rising, triggering migraines in susceptible women.

However, it's important to remember that not everyone with migraines is sensitive to histamine. Rather than unnecessarily restricting your diet, I would usually recommend keeping a food and symptom diary to identify whether particular foods consistently coincide with your migraines. Sometimes it's not the food itself but a combination of factors. For example, you might normally tolerate a glass of red wine, but drinking it after a stressful day, a poor night's sleep and just before your period could be enough to cause your migraine bucket to overflow.

The Gut-Brain Connection: Does Gut Health Matter?

You may have heard that around 90–95% of the body's serotonin is produced in the gut. Serotonin plays an important role in digestive function, but it's also involved in the neurological pathways associated with migraines. Although serotonin produced in the gut doesn't directly enter the brain, researchers are increasingly interested in the relationship between our gut microbiome, inflammation, immune signalling and the nervous system. This communication between the gut and brain is known as the gut-brain axis. Emerging research suggests that differences in the gut microbiome may be associated with migraines. Supporting good gut health is beneficial for our overall wellbeing, particularly during midlife when changes in hormones, digestion and metabolism can all interact.

One way to support a healthy gut microbiome is to eat a wide variety of plant foods, including vegetables, fruits, legumes, nuts, seeds, herbs and spices. You may have heard of the recommendation to aim for 30 different plant foods each week. This can be a useful way to encourage dietary diversity and provide a broad range of fibres and polyphenols that nourish our beneficial gut bacteria. Fermented foods such as kefir, live yoghurt, sauerkraut and kimchi can also contribute to dietary diversity, although they may not be suitable for everyone, particularly if you suspect histamine-rich foods trigger your migraines.

Can Phytoestrogens Help Hormonal Migraines?

Phytoestrogens are naturally occurring plant compounds that have a similar, although much weaker, structure to our body's own oestrogen. This means they can attach to some of the same oestrogen receptors in our cells, but their effects are much gentler. Interestingly, depending on the type of receptor and the hormonal environment, phytoestrogens can have either mild oestrogen-like effects or can block our own oestrogen from binding to the receptors, potentially reducing some of its effects. This is why they're sometimes described as having a modulating or balancing effect on oestrogen activity, rather than simply increasing oestrogen levels. They've attracted interest for their potential role in supporting women through menopause, particularly in relation to symptoms such as hot flushes as they may help to balance hormones and counteract the oestrogen fluctuations responsible for hormonal migraines.They're found in foods such as tofu, tempeh, edamame beans, soya milk, soya yoghurt, ground flaxseed and chickpeas. Soya foods also provide a valuable source of plant protein, while flaxseeds and legumes contain fibre and other nutrients that support digestive and cardiovascular health.

Key Nutrients That May Support Migraine Management

When looking at migraines from a nutritional perspective, certain vitamins and minerals are particularly interesting because of their roles in nervous system function, energy production and pain signalling. Magnesium is one of the most extensively researched nutrients in relation to migraine prevention. It's involved in hundreds of biochemical reactions throughout the body, including nerve transmission, muscle function and the regulation of neuronal excitability. Research suggests that magnesium supplementation may help reduce migraine frequency in some people, particularly those experiencing menstrual migraines. Good dietary sources include pumpkin seeds, cashews, chia seeds, leafy green vegetables, black beans and wholegrains.

B vitamins play an important role in several biochemical processes, including oestrogen metabolism, homocysteine regulation and methylation and are also essential for healthy nervous system function. Vitamin B6, for example, is involved in the production of neurotransmitters such as serotonin, supports metabolic pathways involved in histamine breakdown, which may be particularly relevant for women experiencing hormonal migraines. Riboflavin (vitamin B2) has some of the strongest evidence among nutritional supplements for migraine prevention, particularly at doses higher than those typically obtained through diet. Good food sources of B vitamins include eggs, dairy products, meat, fish, legumes and fortified cereals.

Zinc is another nutrient involved in numerous neurological and metabolic processes, including antioxidant defence and immune function. It can be found in oysters, beef, pumpkin seeds, sesame seeds, chickpeas and wholegrains.

Iron is also worth considering, particularly for women experiencing heavy menstrual bleeding during perimenopause. Heavy periods can contribute to depleted iron stores and iron deficiency anaemia, which may cause fatigue, dizziness and headaches. Although iron deficiency isn't necessarily the cause of migraines, identifying and correcting a deficiency may help improve overall wellbeing and reduce an additional burden on the body.

It's important to remember that more isn't always better when it comes to supplements. The most appropriate nutrients and dosages will depend on your individual circumstances, dietary intake, medical history and any medications you're taking.

Blood Sugar, Hydration and Sleep – The Everyday Triggers

Sometimes, when we're looking for complicated explanations for migraines, it's easy to overlook some of the more straightforward factors that may be contributing. Skipping meals, going for long periods without eating, dehydration and disrupted sleep are all recognised migraine triggers for some people. During perimenopause, these factors may become particularly relevant as hormonal fluctuations can affect sleep quality, energy levels and appetite.

Eating regular, balanced meals containing protein, fibre-rich carbohydrates and healthy fats can help provide a steady supply of energy throughout the day. For example, rather than grabbing a piece of toast or skipping breakfast altogether, you might choose eggs on wholegrain toast, Greek yoghurt with berries and seeds, or porridge topped with nuts and a source of protein.

Staying well hydrated is equally important. Dehydration can trigger headaches in susceptible individuals, so try to drink water consistently throughout the day rather than waiting until you feel thirsty.

Caffeine is another interesting factor. For some people, a small amount can help relieve a headache, while for others, excessive caffeine or suddenly reducing their usual intake can trigger a migraine. Consistency is often more important than completely eliminating it.

Sleep also deserves particular attention. Many women experience disturbed sleep during perimenopause, whether due to night sweats, anxiety or waking in the early hours. Poor sleep can lower our migraine threshold, while migraines themselves can disrupt sleep, creating a frustrating cycle. Supporting a regular sleep routine, managing stress and incorporating gentle movement into your day can all help reduce some of the additional pressures on your nervous system. Returning to our bucket analogy, these changes may not remove the hormonal fluctuations filling your bucket, but they could help prevent some of the additional water from being added.

Can Nutrigenomic Testing Help Us Understand Hormonal Migraines?

Another area I explore in my nutritional therapy practice is nutrigenomic testing, which looks at how variations in our genes may influence the way our bodies respond to nutrients and process certain substances. For women experiencing hormonal migraines, this can provide additional insights into genetic tendencies relating to oestrogen metabolism, methylation and histamine breakdown. For example, variations in genes such as COMT and MTHFR may influence pathways involved in oestrogen metabolism and methylation, while variations in genes associated with DAO and HNMT may affect histamine metabolism. Understanding these genetic tendencies, alongside your symptoms, diet and lifestyle, may help inform a more personalised nutritional approach.

Looking at the Bigger Picture

One of the most useful things you can do if you're experiencing migraines during perimenopause is to start looking for patterns. Keeping a migraine diary alongside your menstrual cycle can help you identify whether your headaches tend to occur around ovulation, before your period or during the first few days of menstruation. It can also be helpful to record your sleep, stress levels, food intake, hydration and any other symptoms you experience. Over time, you may begin to notice that certain combinations of factors are more likely to trigger a migraine than others.

As a Registered Nutritional Therapist specialising in women's health and perimenopause, I take a personalised approach to understanding the factors that may be contributing to your symptoms. Rather than focusing on a single food or nutrient, we can explore your overall diet, eating patterns, nutrient intake, gut health, sleep and lifestyle. Where appropriate, we can also consider whether further investigations, such as checking iron status, may be helpful through your GP. By understanding your individual migraine triggers and addressing the factors within your control, it may be possible to reduce some of the additional pressures that contribute to migraine attacks.

This Menopause Awareness Month, Let's Talk About Migraines

This year's World Menopause Day theme, Chronic Pain at Midlife, is an important reminder that menopause-related symptoms extend far beyond hot flushes and changes to our menstrual cycles. For many women, pain is something they quietly learn to live with, carrying on with work, family responsibilities and everyday life despite feeling far from their best. Migraines are one example of how significantly hormonal changes can affect our wellbeing, and they deserve to be taken seriously.

If your migraines have become more frequent or troublesome during midlife, it's worth exploring what might be contributing to them rather than simply accepting them as another inevitable part of getting older. Remember that migraine bucket. You may not be able to control every drop of water going into it, particularly when your hormones are fluctuating, but making small, consistent changes to your nutrition and lifestyle may help prevent it from overflowing quite so often.

If you're struggling with migraines or other symptoms of perimenopause and would like to explore how nutritional therapy might support you, I'd love to help. I offer a free 30-minute Midlife Health Review, where we can discuss your symptoms, health goals and whether nutritional therapy might be right for you. To arrange your free call, email hello@lisafossey.com or visit www.lisafossey.com.