Your migraine may shift around the menopause. Record attacks and your cycle over months so the change shows up in your own numbers.

Your migraine may have changed around the menopause, becoming more frequent, rarer, or different in course. There is no single rule. What you live through shows up in your own record over time. Keep it on paper or in the migraine diary in Sam, which once a month shows you the MIDAS questionnaire. No advice on hormones appears here. Those decisions belong with your doctor.

How migraine can change around the menopause

The menopause is not a phase with one fixed course. The transition before it, the perimenopause, is hard to predict for migraine. A 2026 narrative review in the journal Headache by Korn and Bernstein notes that when hormones vary strongly in this time, the frequency and course of attacks can change. Attacks can lose their earlier rhythm.

After the menopause there are two common directions. The Migraine Trust says attacks often become less severe and less frequent, and they may even stop. That is not immediate, as hormones can take a few years to settle. Migraine does not always improve, the charity adds. It is more likely to continue or worsen after surgical menopause, such as removal of the womb or ovaries.

A systematic review by Ripa and colleagues found mixed results. Studies in the general population reported improvement after the menopause, with a possible rise in perimenopause. Studies in headache clinics found no improvement or even worsening. The 2026 narrative review notes that migraine without aura often improves after the menopause, while migraine with aura tends to persist. These statements describe groups. They do not describe your personal course, and they do not decide whether your migraine "comes from the menopause". Your doctor works that out with you.

Why recording over months helps

One month says little. Over several months you see whether your pattern really shifts: whether attacks cluster, become rarer, or whether your cycle and migraine line up in time. That is exactly what a diary is for. The Migraine Trust places the record at the centre of the conversation with your doctor, and our new-diagnosis guide migraine diagnosis: what now shows how the record fits the first weeks.

Daily entries carry facts that add up. Which triggers play a part for you is covered in migraine triggers: sleep, stress and tracking. The connections you read from the record, you discuss with your care team. Sam does not draw a link on its own.

What you record in your entries

In the migraine program you keep, for each attack, the start time, strength and duration, whether aura came, and which symptoms bothered you. For an entry made today, Sam adds sleep and heart rate variability from Apple Health when a value exists. You enter only what you know yourself.

You keep the cycle separately. In cycle tracking you note period days and how heavy the bleeding is. Symptoms that are not part of an attack, or a note you want to add on a headache-free day, go in the symptom diary. That keeps migraine and cycle as two records you place side by side when you want to see a connection. Each gets its own report, which helps because each record stays separate and you decide which to bring together. For a clear overview of the phases, see migraine symptoms: aura and phases. And if attacks feel like they are piling up, chronic migraine: how many days count explains the boundary a doctor uses.

Bringing the course to your appointment

The course matters most at the appointment. In the migraine program you get your migraine days as a doctor report in PDF for the period you choose. That way your doctor or specialist sees the change over weeks or months at a glance, instead of following memory. The MIDAS migraine score shows how strongly migraine limits your daily life. It does not replace a medical opinion. If someone comes with you, that person can help you remember what to ask.

When something feels new or different

Not every change is the menopause. Describe what feels new, and do not just wait. Sudden speech problems, weakness or numbness on one side, a sudden loss in your field of vision, or a headache that builds suddenly and extremely: call your local emergency number (112 in the EU, 999 in the UK, 911 in the US), even if you know migraine with aura. If vision changes such as light flashes or zigzag lines appear for the first time, get urgent medical advice (in the UK, an urgent GP appointment or NHS 111). This guidance is general and does not replace a medical opinion. Sam does not recognise an emergency by itself and does not diagnose. When in doubt, call your doctor or the emergency number.

Record your change over months in Sam and take the report along

You arrive with a course instead of a guess. Over one, three or six months you see for yourself how your pattern shifts. The migraine program in Sam holds this for you:

• Instead of a paper calendar: each attack with start, strength, duration and aura, and in the note what you experienced that day.
• Instead of loose notes: sleep and heart rate variability come from Apple Health, and you enter only what you know yourself.
• Instead of counting by hand: the doctor report as a PDF sums up the period you choose, and the cycle has its own record.

Sam does not detect a pattern on its own and does not diagnose. Whether and why your migraine is changing is judged by your doctor or specialist.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Migraine diagnosis: what now
• Migraine triggers: sleep, stress and tracking
• Chronic migraine: how many days count
• Migraine symptoms: aura and phases

Sources

Updated: October 2026

• The Migraine Trust: Migraine and menopause (last reviewed March 2025)
• NHS: Headaches (last reviewed 17 April 2024)
• Korn TF, Bernstein C: Migraine across the menopausal transition and beyond: a narrative review. Headache 2026;66(6):1390-1404
• Ripa P, Ornello R, Degan D, et al.: Migraine in menopausal women: a systematic review. Int J Womens Health 2015;7:773-782