It should come as no surprise then, that as levels of estrogen fall in menopause, women frequently undergo increased incidences of headache and changes in normal headache patterns.
Most menopausal symptoms, including headaches, respond well to hormone replacement therapy; this further establishes the link between neurochemicals and biological hormone levels. Also confirming this link are various studies which have shown that cluster headaches in women improve with pregnancy.
Finally, migraine suffering women with a history of headaches being intensified during menses, headache improvement with pregnancy, or worsening headache with the use of birth control pills, tend to experience worsening of migraine headache during the menopause.
Other studies, however, are inconclusive on whether menopause causes headche, and as yet, there have been no actual controlled studies of migraine patients entering into and going through menopause to pinpoint the precise effects of menopause on migraine or headache.
Most of the existing studies are retrospective questionnaire-type studies, which are fairly subjective in nature. For example, a meta-analysis of these results show preexisting migraine worsens in 9% to 42% of women, improves in 8% to 36%, and remains unchanged in 27% to 64% in menopause.
The withdrawal from estrogen during menopause has effects on the central nervous system which are believed to how the classic symptoms- hot flashes, headaches, mood changes- are brought out during the menopause. The same neurotransmitter systems affected during menstrual migraines also seem to be affected by menopause. Hypothalamic nuclei opioid tonus, decreased blood serotonin levels, and up-regulation of some serotonin receptors have been verified in studies of postmenopausal women.
Estrogen and progesterone both have a big role in neurological activity and receptor density. Serotonin is a neurotransmitter released in the brain in response to certain triggers and can cause vascular dilation. High estradiol hormone levels are connected with high levels of serotonin and, on the other hand, low levels of serotonin are associated with low levels of estrogen.
During a pregnancy, estradiol and serotonin levels are higher, and headaches often are diminished. During ovulation and menstruation, there is a lower level of estradiol and serotonin, and headaches increase in frequency. This pattern helpd explain headaches in menopause.
Preventive treatments for headaches and migraines caused by menopause have been the most effective; they include beta blockers, antidepressants, calcium channel blockers, serotonin reuptake inhibitors (SSRIs), and anticonvulsants. For treatment after the onset of headache, the nonsteroidal anti-inflammatory drugs (NSAIDs) are successful for some; both over-the-counter and prescription strengths are useful. Avoidance of an individuals known headache trigger is also an important factor. Triggers may include such things as foods with tyramine in them, nitrates, nitrites, monosodium glutamate, allergies, and alcohol.