Headaches are a common perimenopausal symptom. Some women will experience migraine headaches for the first time during this period, or a worsening of a long-standing migraine condition. Others will notice an increase in tension headaches. Whether it is migraine or tension, a headache can seriously limit your productivity and well-being.

Migraine Headaches

Migraine headaches are vascular, and are caused by blood vessels in the head enlarging, and then nerves around the blood vessels releasing chemicals that cause inflammation and pain. This migraine event usually triggers the “sympathetic” nervous system, the so-called “fight or flight” response, and thereby may cause nausea, vomiting, and diarrhea.

Since migraine headaches are sensitive to hormone shifts, women tend to have more of them during times when hormones fluctuate, such as the premenstruum, pregnancy, and menopause. They can be little more than a nuisance, or they can be debilitating events that put you out of commission for days at a time.

Some women experience an advanced warning other than an aura that comes days or hours before the headache. It may take any of a number of forms, including:

• Irritability

• Sadness

• Euphoria

• Sleepiness

• Yawning

• Food cravings

People with this sort of migraine learn to heed the warning and seek treatment before the headache hits. Often there are triggers for migraine headaches, including foods (aged cheese, coffee, chocolate, pickled items, and others), changes in sleep patterns (too much or too little), stress, artificial sweeteners such as aspartame, fasting, odors, alcohol, food additives such as monosodium glutamate (MSG), bright and flashing lights, and others. Sometimes avoiding triggers is effective in reducing the headaches significantly.

There are many ways to treat migraine headaches, some of them requiring prescription and some available over the counter. Combining caffeine with common pain medications is effective for some. Others find that they need to try prescription medications such as triptans or ergot formulas. Talking to your health care provider is important to determine which medications are best for you, and which will not interact badly with other medications you may be taking.

Non-medication approaches for migraine headaches include relaxation techniques and biofeedback. Ice can be effective in aborting headaches, and getting sufficient sleep is also important in preventing migraine attacks.

Non-Migraine Headaches

A non-migraine headache is usually called a “tension headache.” As with migraines, these are more common in women than men, and often begin in middle adulthood. Tension headaches, as the name implies, seem to result in the muscular tension in the neck and shoulders. As life, work and family become increasingly stressful, women notice more severe and more frequent tension headaches. Tension headaches may be associated with anxiety or depression, and are often treated successfully.

Treatment of tension headaches may be with common pain medications such as ibuprofen or acetaminophen, or with relaxation techniques and biofeedback, or some combination of the two. The most effective approach also is one that reduces the stress that causes the headache to begin with (more about stress management in Chapter 8). Some women find that chiropractic care, acupuncture, and/or massage can significantly reduce the number or severity of their tension headaches.