Hormone Therapy Linked to More Frequent Migraines, but Not Greater Severity, in Postmenopausal Women

Postmenopausal women using hormone therapy had more frequent migraine attacks and more migraine days per month, but no increase in migraine severity or analgesic use. The findings come from a systematic review and meta-analysis presented at the 2026 Annual Meeting of The Menopause Society in San Diego.^1,2

The Menopause Society cautioned that the association may reflect differences between women who choose hormone therapy and those who do not, rather than an effect of the therapy itself.¹

Migraine is estimated to affect 10% to 29% of women during the menopause transition, when attacks often become more frequent, particularly during perimenopause as estrogen levels fluctuate unpredictably. Hormone therapy effectively treats many bothersome menopause symptoms, especially hot flashes, but changes in estrogen levels may influence migraine.^1,2

Study design

Flavia Fairbanks Ruano, MD, PhD, of the University of Miami Miller School of Medicine, and colleagues searched PubMed, Embase, the Cochrane Library, and Scopus through March 2026. They included studies reporting migraine outcomes in postmenopausal women using hormone therapy, regardless of route of administration.²

Data extraction followed PRISMA guidelines, and pooled estimates were calculated with random-effects models. Outcomes included migraine incidence, severity, frequency, duration, and analgesic use.²

Key findings

Five studies with a combined 23 702 women were included in the analysis. The pooled mean migraine incidence was 18.94% (95% CI, 12.90%-26.93%).²

Compared with women not using hormone therapy, those using it had²:

• More migraine attacks (mean difference [MD], 1.16 attacks/month; 95% CI, 0.19-2.14)
• More days with migraine (MD, 0.95 days/month; 95% CI, 0.23-1.67)

The groups did not differ significantly in monthly analgesic use (MD, 0.70; 95% CI, −1.60 to 3.00) or migraine severity scores (MD, 0.11; 95% CI, −0.08 to 0.31).²

The authors concluded that hormone therapy may increase migraine burden without affecting symptom intensity or treatment needs. Fairbanks Ruano noted that more research is needed to clarify the relationship and to guide individualized treatment decisions.^1,2

Stephanie Faubion, MD, MBA, medical director of The Menopause Society, emphasized that hormone therapy remains the most effective treatment for bothersome vasomotor symptoms and "can be used safely in many women with migraine."¹

She noted that women with migraine may be more likely to seek treatment for menopause symptoms, which could bias the results. Further research is needed before drawing conclusions about the effect of hormone therapy on migraine, she added.¹

Limitations

The analysis included only 5 studies, and the abstract does not report the heterogeneity estimates or how many studies contributed to each outcome.² Because the pooled incidence describes women using hormone therapy, it does not on its own show a higher incidence compared with nonusers. The results also do not distinguish between formulations, doses, or routes of administration.² The authors called for clinical trials to clarify the underlying pathophysiology.²

References:

1. The Menopause Society. Hormone therapy use associated with greater migraine burden in postmenopausal women. News release. October 20, 2026. Accessed October 21, 2026. https://menopause.org/press-releases/hormone-therapy-use-associated-with-greater-migraine-burden-in-postmenopausal-women
2. Fairbanks Ruano F, Fonseca Queiroz L, Lemos M, et al. Impact of hormone replacement therapy on migraine outcomes in postmenopausal women: a systematic review and meta-analysis. Abstract P-34. Presented at: 2026 Annual Meeting of The Menopause Society; October 20-24, 2026; San Diego, CA.