Hormone Therapy Linked to More Frequent, Longer Migraines After Menopause

This article is based on The Menopause Society's report of the study. The paper itself was not reviewed. The work will be presented at the society's 2026 Annual Meeting in San Diego, October 20–24, so it is a conference presentation.

According to the report, researchers set out to look at how hormone therapy relates to migraine in postmenopausal women. They looked at how often migraines occur, how severe they are, how often they happen, how long they last and how much pain medicine is used. They did this regardless of how the hormone therapy was taken.

The Menopause Society says the analysis was a systematic review and meta-analysis. That means it combined results from earlier studies. According to the report, it drew on five studies that together included nearly 24,000 women. The pooled analysis showed an average migraine incidence of 18.94%.

The Menopause Society reports that hormone therapy was linked to more frequent migraine attacks and longer migraine episodes. It also reports that the researchers found no significant differences in the number of pain relievers used per month or in migraine severity scores.

Context matters here. According to the report, migraines are estimated to affect 10% to 29% of women during the menopause transition. They often worsen and become more frequent then, especially in perimenopause. The society attributes this to unpredictable drops in estrogen. Hormone therapy is described as effective for bothersome menopause symptoms, especially hot flashes. A challenge is that changes in estrogen levels may influence migraine.

The report urges caution on cause. Dr. Stephanie Faubion, medical director for The Menopause Society, says women with migraine may be more likely to seek treatment for menopause symptoms. The findings, she says, may reflect underlying differences between women who use hormone therapy and those who do not. In other words, the link could run in either direction, or come from something else. She adds that more research is needed before conclusions are drawn about the effect of hormone therapy on migraine burden.

Faubion also says hormone therapy remains the most effective treatment for bothersome vasomotor symptoms, such as hot flashes, and can be used safely in many women with migraine.

Dr. Flavia Fairbanks Ruano of the University of Miami Miller School of Medicine, the lead author, says more research is needed to understand the relationship and to help guide individualized treatment decisions. The report says further clinical trials are needed to understand the biology and to guide more effective treatments.

What this means for personal decisions is not yet settled. The report does not offer a list of questions for women with migraine. It does point to one open issue: whether any added migraine burden comes from the therapy itself or from who chooses it. Those are questions for a woman and her own clinician to weigh together.

On a related topic, The Arising reported on October 21 that FIGO and the International Menopause Society urge long-term hormone therapy for women with early menopause. That is a separate matter from this analysis, which looks at migraine in postmenopausal women, so the two add different pieces to the wider picture of hormone therapy.

Watch for the full presentation and any peer-reviewed paper, which would show how the studies were chosen and how strong the findings are, along with the clinical trials the researchers say are needed.

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