Sumasakit ang ulo lagi? Headaches in perimenopause

• A sudden, severe headache, the "worst of your life", that peaks within a minute or so
• Headache with weakness, numbness, face drooping, slurred speech or vision loss
• Headache with fever and a stiff neck, or after a head injury
• A new headache with very high blood pressure

These are not menopause symptoms. They need urgent care.

Estrogen affects pain pathways and blood vessels in the brain. Many women with migraine notice attacks linked to the drop in estrogen just before a period. In perimenopause, estrogen swings more wildly, so those drops come at random. The National Migraine Centre notes that in the years before menopause, attacks can become more frequent and sometimes last longer; for hormone-linked migraine, things often ease after menopause, though that can take two or three years.

Other midlife triggers add up: poor sleep from night sweats, stress, skipped meals, dehydration in Philippine heat, and too much or too little coffee.

At the 2025 UP Manila symposium, PGH doctors cited an older Filipino study that found headache was the most common menopause symptom, and hot flashes the least (UP Manila). Filipinas on Reddit also say doctors labelled their symptoms "muscle pain, migraine or stress" and sent them home with pain relievers.

• High blood pressure. Common at midlife. Check it.
• Thyroid problems. A TSH test costs ₱490 per test (Exact Check).
• Anemia from heavy periods.
• Eye strain and needing reading glasses, very common in the 40s.
• Medication overuse headache. Taking simple pain relievers (such as paracetamol or ibuprofen) on 15 or more days a month, or triptans or combination painkillers on 10 or more, for over 3 months can itself cause frequent headaches (Migraine Trust).
• Depression and anxiety. See mood and anxiety.
• Sleep apnea, if you wake with headaches and snore. See sleep.
• Medicines, including some blood pressure tablets and HRT itself in some women.

Track your headaches alongside your cycle in the symptom diary or period tracker, and note them in the symptom checker.

A headache log makes the consult far more useful. For two to four weeks, write down:

• The day and time each headache starts, and how long it lasts
• Where it hurts and what it feels like (throbbing, pressing, one side or both)
• Whether you see flashing lights or zigzags before it (aura)
• Where you are in your cycle, if you still have periods
• What you took for it, and how many days a month you take pain relievers
• Your blood pressure, if you can check it at home

Also mention hot flashes, night sweats and poor sleep. Together they help your doctor see whether hormones are part of the picture.

Evidence on menopause headaches specifically is thinner than for hot flashes. Medicines are prescription only.

Migraine treatment from a doctor. Some evidence. Standard migraine medicines and preventive options work at midlife too. A neurologist or your GP can help.

Hormone therapy. Not enough evidence for headaches. HRT is not a headache treatment. The Australasian Menopause Society says migraine is not a reason to avoid HRT, and that steady estrogen through the skin (a transdermal gel) is preferable to tablets. The Migraine Trust says transdermal estrogen can also be used safely by women with migraine aura, and that for women with migraine, progestogens are best taken continuously. Your doctor will still want to know about any aura before choosing a route and dose. See HRT for menopause. Estradiol gel (Oestrogel): ₱1,185.50 per 80 g pump pack (Watsons).

Non-hormonal medicines for flashes. Not enough evidence for headaches. If flashes and poor sleep drive your headaches, options on non-hormonal treatments may help indirectly.

Regular sleep, meals, water and steady caffeine. Limited evidence. Simple, free, worth trying.

Supplements. The Migraine Trust lists riboflavin and magnesium as supplements some people use to try to prevent migraine, but says the evidence is often limited. Ask a doctor first, and see our honest supplement ratings.

Prices checked October 2026.

If your doctor says it is "just stress", our talk to your doctor guide helps, and find a doctor lists menopause-literate clinicians.