You may know someone whose migraines faded after menopause, and someone else whose attacks got worse.
For many women, hormones and headaches have been tangled together for decades. The decision around hormone therapy carries all of that history.
A new review brings that question into clearer focus. Postmenopausal women on hormone therapy had about 1.16 times more migraine attacks per month than women not on therapy.
Their episodes also lasted roughly one extra day.
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The findings were presented at The Menopause Society's 2026 Annual Meeting in San Diego and summarized by Medical Xpress. Pain intensity and painkiller use did not change.
The analysis pooled data from five earlier studies covering 23,702 postmenopausal women. About 19 percent of them had migraines.
The research was led by Dr. Flavia Fairbanks Ruano at the University of Miami Miller School of Medicine. It is a conference abstract and has not yet been peer-reviewed.
An extra day a month
According to Healio, the review found a 1.16-fold increase in monthly attacks and about 0.95 additional days of migraine.
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Pain scores and painkiller use were essentially unchanged.
For a woman who already has three migraine days a month, that works out to roughly half a day to one day more.
That is not nothing. But it is also far from the dramatic worsening many women fear when they are told their migraines rule out hormone therapy.
Why this does not automatically rule out hormone therapy
Estrogen is a known migraine trigger. Falling estrogen levels around a period, and the rolling changes of perimenopause, are a classic reason attacks ramp up.
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After menopause, when estrogen settles at a low baseline, migraine often eases on its own.
That biology helps explain why adding estrogen back in can nudge headache counts up. It does not explain the whole picture.
Women who seek hormone therapy may already have more severe menopause symptoms, including migraine. The review cannot untangle cause from selection.
Dr. Stephanie Faubion is medical director of The Menopause Society.
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"Hormone therapy remains the most effective treatment for bothersome vasomotor symptoms and can be used safely in many women with migraine," she told News-Medical. Vasomotor symptoms are the medical term for hot flashes and night sweats.
She added that more research is needed before drawing firm conclusions about the effect of hormone therapy on migraine burden.
What women can discuss with their doctor
The review did not separate oral estrogen from the patch or gel versions worn on the skin. That matters in practice.
Menopause specialists often lean toward skin-delivered estrogen for women with migraine. Steady doses through the skin avoid the hormone peaks and dips that pills create.
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Other practical options include keeping a headache diary, trying a lower dose, or moving from a cyclical regimen to a continuous one.
The goal is to keep hormone levels flatter from day to day. None of these changes should be made without talking to the prescribing doctor.
The research was presented at The Menopause Society's Annual Meeting on October 20 to 24, 2026, in San Diego. The full paper is not yet peer-reviewed.
This article is made and published by Ida-Marie Palm Varbæk, who may have used AI in the preparation.