EDUCATION

Migraine in Women

Hormones, contraception, pregnancy, and menopause all interact with migraine in important ways. A practical guide for women and the providers who care for them.

Last reviewed: October 2026
A woman resting in a quiet, dim room during a migraine
01 — Women & Migraine

The migraine gender gap

Migraine is 3x more common in women than men

About 1 in 5 women and 1 in 16 men experience migraine. The gap emerges at puberty and persists through midlife.

Why? Hormones play a central role

Fluctuations in estrogen (the main female sex hormone) across the menstrual cycle, during pregnancy, and around menopause are powerful migraine triggers. The trigeminal nerve and pain-processing pathways also respond differently in women.

Women have longer, more disabling attacks on average

On average, women with migraine miss more work, have more severe pain, and experience more associated symptoms like nausea.

Last reviewed: October 2026
02 — Women & Migraine

Menstrual migraine

What it is

Migraine attacks that occur in a predictable window around menstruation — typically 2 days before through 3 days into the period.

How common

Up to 70% of women with migraine report menstrual-related attacks. About 7-14% have "pure menstrual migraine" with attacks ONLY during this window.

Why it happens

The natural drop in estrogen that triggers menstruation also affects serotonin and other neurotransmitters — chemical messengers in the brain involved in migraine.

Pure menstrual migraine is harder to treat

Often requires longer-acting preventive strategies that cover the full menstrual window — including perimenstrual NSAID protocols (anti-inflammatory pain medicines like ibuprofen) or miniprophylaxis with triptans or gepants (modern migraine medications).

Last reviewed: October 2026
03 — Women & Migraine

Contraception and migraine

Combined oral contraceptives (with estrogen)

Can worsen migraine with aura (temporary warning symptoms such as flashing lights or zigzag lines), increase stroke risk, and produce more frequent attacks. Should be discussed carefully with a provider, especially in women who have migraine with aura.

Progestin-only options (minipill, hormonal IUD, implant, injection)

Generally safer and often neutral or beneficial for migraine. The hormonal IUD (Mirena, Liletta) is often a good choice for women with menstrual migraine.

Continuous-use oral contraceptives

Eliminating the hormone-free interval can reduce menstrual migraine by avoiding the estrogen drop. Some providers prescribe this specifically for migraine management.

Last reviewed: October 2026
04 — Women & Migraine

Pregnancy and migraine

Many women improve during pregnancy

Up to 70% report fewer attacks, especially in the 2nd and 3rd trimesters. Estrogen levels are high and stable during this time.

Some women worsen, especially in the 1st trimester

Hormonal changes, dehydration, sleep disruption, and stress can all trigger attacks early in pregnancy.

Treatment is more limited

Many migraine medications are not safe in pregnancy. Acetaminophen is the first-line acute treatment. Magnesium, riboflavin, and certain other preventives can be used. Procedures like TEMMA® are generally deferred until postpartum.

Headache in pregnancy can be a warning sign

New severe headache in pregnancy — especially with high blood pressure, vision changes, or upper abdominal pain — needs urgent evaluation for preeclampsia (dangerously high blood pressure in pregnancy).

Last reviewed: October 2026
05 — Women & Migraine

Perimenopause and menopause

Perimenopause often makes migraine worse

Hormonal fluctuations during the transition to menopause are unpredictable. Many women have their worst migraine years in their late 40s.

After menopause, many women improve

Once estrogen stabilizes at low levels, menstrual migraine typically resolves. About 60-70% of women report improvement post-menopause.

Surgical menopause (hysterectomy with ovary removal)

Can trigger severe migraine worsening if not managed with gradual hormone replacement. Discuss with your provider.

HRT (hormone replacement therapy) in menopause

Transdermal estrogen (patch, gel — estrogen through the skin) at the lowest effective dose is generally safer than oral estrogen for migraine. Continuous rather than cyclic use avoids the hormone-free interval.

Last reviewed: October 2026
06 — Women & Migraine

Special considerations

Women are more likely to have migraine with aura

About 30% of women with migraine experience aura, compared to lower rates in men. Aura with combined hormonal contraception is a particular concern.

Chronic migraine is more common in women

About 1.5-2x more common than in men (chronic means migraine 15 or more days a month), partly because menstrual and hormonal patterns can push episodic migraine into chronic.

Migraine can affect pregnancy outcomes

Uncontrolled migraine — especially with aura — is associated with slightly increased risk of preeclampsia, preterm birth, and low birth weight. Good management matters.

Treatment response can vary by cycle phase

Some women find that triptans or NSAIDs work better at certain points in the cycle. Tracking response can help optimize timing.

A Non-Hormonal Option

If your migraine is hormonal and severe

For women whose migraine is tied to hormonal cycles and is not well-controlled with standard approaches, TEMMA® offers a non-hormonal, drug-free option. It targets the underlying migraine pathway — not the hormone cycle.

Learn About TEMMA®
Keep Reading

More from the migraine education library

01Types of MigraineChronic, episodic, with aura, without aura, hemiplegic, vestibular, menstrual — understanding the differences.Read article →02Common TriggersHormonal, dietary, lifestyle, stress, and physical triggers — and how to identify your personal ones.Read article →03Treatment OptionsA plain-language guide to medications, devices, behavioral approaches, and procedures including TEMMA®.Read article →04When to See a DoctorRed flag symptoms that need urgent care, and how to make the most of your appointment.Read article →Currently readingMigraine in WomenMenstrual migraine, contraception, pregnancy, perimenopause, and menopause — hormonal migraine specifics.Read article →06Living with MigraineSleep, exercise, stress, work, and relationships — daily choices that shape how migraine affects you.Read article →07The MMA PathwayWhy the middle meningeal artery and the dura matter so much in migraine — and what that means for treatment.Read article →08GlossaryAura, CGRP, dura, embolization, neurointerventional, refractory — every term, defined.Read article →

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