For millions of women, menopause already comes with enough challenges. Hot flashes, night sweats, disturbed sleep and mood changes can make everyday life difficult. But for those who also experience migraines, the transition can become even more complicated.
Many women turn to hormone replacement therapy, commonly known as HRT, to ease their menopause symptoms. The treatment is widely recognized as one of the most effective ways to manage hot flashes and night sweats.
However, new research suggests that hormone therapy could be associated with an unexpected problem for women who experience migraines.
According to findings announced by The Menopause Society, postmenopausal women using hormone therapy reported more frequent migraine attacks and episodes that lasted longer than those experienced by women who were not using the treatment.
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The research examined five studies involving nearly 24,000 women and was scheduled for presentation at The Menopause Society's 2026 Annual Meeting in San Diego, taking place from October 20 to 24.
But the researchers also discovered something important: although migraines occurred more frequently and lasted longer, the attacks were not significantly more painful.
Nearly 24,000 women were included in the research
The analysis was conducted by researchers at the University of Miami Miller School of Medicine, who wanted to understand how hormone therapy might affect migraines after menopause.
Instead of recruiting patients for a new clinical trial, the team combined results from five existing studies involving almost 24,000 postmenopausal women.
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They examined several aspects of migraine, including how often attacks occurred, how long they lasted, how severe the pain became and whether women needed to take more pain medication.
Across the studies, the average reported migraine incidence was approximately 18.9 percent. However, that figure does not mean hormone therapy caused migraines in nearly one in five women.
When researchers compared the findings, they identified an association between hormone therapy and a greater number of migraine attacks, alongside longer-lasting episodes.
Interestingly, they did not find statistically significant differences in migraine severity scores or in the number of pain-relieving medications used each month.
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That distinction matters because the results do not suggest that every migraine becomes more painful when someone uses hormone therapy.
Instead, the findings indicate that some women receiving the treatment may experience migraines more frequently or for longer periods, without necessarily experiencing a significant increase in pain intensity.
The publicly released summary did not provide an exact percentage increase in attack frequency or duration, so it remains unclear how large those differences were.
Why menopause can make migraines worse
The connection between menopause and migraines is not entirely new.
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Researchers have known for years that fluctuations in estrogen, one of the body's main reproductive hormones, can influence migraine attacks.
During a woman's reproductive years, estrogen levels naturally rise and fall throughout the menstrual cycle. For some people, the sudden drop in estrogen before menstruation can trigger migraines.
These hormonal changes become particularly unpredictable during perimenopause, the years leading up to menopause.
According to the American Migraine Foundation, women who experience hormone-related migraines may notice that their attacks become more frequent, longer or more difficult to manage during this transition.
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Menopause symptoms can also indirectly influence migraines. Night sweats may interrupt sleep, while increased stress and changes in daily routines can make some people more vulnerable to attacks.
After menopause, hormone levels usually become more stable. Many women consequently experience an improvement in their migraines, although this does not happen to everyone.
The new research raises questions about whether introducing hormones through menopause treatment could influence migraine patterns even after natural hormone fluctuations have settled.
The type of hormone therapy could make a difference
Although hormone therapy is often discussed as a single treatment, it is actually available in several different forms.
Some women take estrogen tablets, while others use patches, gels or sprays that deliver hormones through the skin. Depending on their medical history, they may also need progesterone or another progestogen alongside estrogen.
These differences may be particularly important for women who experience migraines.
According to the National Migraine Centre, certain hormone treatments can produce greater fluctuations in estrogen levels, potentially triggering migraine attacks in susceptible individuals.
Oral hormone therapy may cause more pronounced changes in hormone levels than patches or gels, which tend to provide a steadier supply of estrogen.
For this reason, specialists often recommend transdermal estrogen, delivered through patches, gels or sprays, for women with migraines who need menopause treatment.
They also generally advise using the lowest effective estrogen dose needed to control menopause symptoms.
These recommendations are supported by a 2025 European Society of Endocrinology clinical guideline, which favors transdermal estrogen for women with a history of migraine with aura who require menopausal hormone therapy.
However, the new University of Miami review did not establish which hormone therapy formulation was responsible for the observed differences.
Its findings therefore should not be interpreted as proof that every type of hormone treatment has the same effect on migraines.
Having migraines does not automatically mean you should avoid HRT
One of the most important messages from the researchers is that the findings should not discourage women from seeking effective treatment for troublesome menopause symptoms.
Dr. Stephanie Faubion, medical director of The Menopause Society, emphasized that hormone therapy remains an important treatment option.
"Hormone therapy remains the most effective treatment for bothersome vasomotor symptoms and can be used safely in many women with migraine," she said.
Vasomotor symptoms are the medical term for hot flashes and night sweats, two of the most common problems experienced during menopause.
For women whose sleep and quality of life are severely affected, controlling those symptoms can provide considerable relief.
In some cases, reducing hot flashes and improving sleep may even help lessen migraines that are triggered by poor sleep or other menopause-related problems.
The Migraine Trust explains that hormone therapy affects women differently. Some notice an improvement in their migraines, while others experience more attacks.
The organization also notes that having migraine with aura, which can involve flashing lights, blind spots or other temporary neurological symptoms, does not automatically rule out menopausal hormone therapy.
However, a woman's migraine history and other cardiovascular risk factors should be considered when choosing the most appropriate treatment.
This is why doctors generally recommend an individualized approach rather than advising every woman with migraines to avoid hormones.
Experts say the study cannot prove hormone therapy causes migraines
There is another important reason to interpret the new findings carefully.
The researchers combined existing studies rather than conducting a new randomized clinical trial designed to establish whether hormone therapy directly causes changes in migraine patterns.
This makes it difficult to separate the effects of hormone treatment from other differences between the women being studied.
For example, women who already experience troublesome migraines may also have more severe menopause symptoms, making them more likely to seek hormone therapy.
If women with worse symptoms are already more likely to receive treatment, that could partly explain why the hormone therapy group reported a greater migraine burden.
Dr. Flavia Fairbanks Ruano, the study's lead author from the University of Miami Miller School of Medicine, said more research is needed to clarify the relationship and help doctors make better treatment decisions for individual patients.
The researchers also emphasized the need for additional clinical trials to understand how hormone therapy may influence migraine frequency and duration.
Another limitation is that the findings were announced for presentation at a scientific conference. The full analysis has not yet been published in a peer-reviewed journal, meaning important details about the methods and results remain unavailable for independent assessment.
For now, the evidence shows an association, not proof that hormone therapy makes migraines worse.
What women taking hormone therapy should look out for
For women already using hormone therapy, the findings are a reason to pay attention to migraine patterns rather than immediately stop treatment.
One practical step is to keep a record of attacks, particularly when starting hormone therapy or changing the dose or formulation.
According to the American Migraine Foundation's guidance on headache diaries, tracking symptoms can help patients and healthcare professionals identify changes and make more informed treatment decisions.
A diary can include how often migraines occur, how long they last, how severe the pain becomes and whether medication is needed. It can also help to note sleep quality, menopause symptoms and any recent changes to hormone treatment.
If someone notices that migraines are becoming more frequent or difficult to manage, their doctor may consider adjusting the hormone dose, changing the formulation or reviewing their existing migraine treatment.
There are also several migraine-specific treatments available, including medications designed to relieve attacks and preventive treatments for people who experience frequent migraines.
As previously reported by Welltica, migraine treatment guidelines have increasingly emphasized selecting therapies according to each patient's symptoms, medical history and response to medication.
Women should not change or discontinue prescribed hormone therapy without consulting their healthcare professional, particularly when the treatment is providing significant relief from menopause symptoms.
The findings raise questions rather than providing a final answer
Migraines affect an estimated 10 to 29 percent of women during the menopause transition, according to The Menopause Society. For many, the unpredictable changes in hormone levels make this one of the most challenging periods of their lives.
The new research adds an important piece to the discussion about how hormone therapy may influence these symptoms.
Its findings suggest that postmenopausal women using hormone therapy may experience migraines more frequently and for longer periods, but they do not establish that the treatment itself causes those changes.
Just as importantly, the study found no significant increase in pain severity or monthly painkiller use.
For women deciding whether to begin or continue hormone therapy, the message is therefore not that the treatment should be avoided.
Instead, the findings reinforce the importance of choosing the right treatment for the individual, monitoring any changes in migraine symptoms and working with a healthcare professional to balance the benefits of menopause treatment against possible side effects.
Hormone therapy can make a meaningful difference to quality of life, and having migraines does not automatically mean women must go without it.
The challenge for researchers is now to determine which women are most likely to experience changes in their migraines and whether different hormone formulations can reduce that risk.
This article is made and published by Aksel Kryhlmand, who may have used AI in the preparation.