Hot flashes during menopause have become an expected—if not exactly welcome—feature of middle age for many women. But few are prepared for the increasing number of severe migraines that can signal menopause is in the offing (a period of time known as perimenopause).

“Periomenopausal migraines can be a debilitating condition that interferes significantly with a woman’s quality of life,” said Margaret Moloney, clinical associate professor in the Nell Hodgson Woodruff School of Nursing. “Add stress from juggling a career, adolescent children and aging parents to hormonal shifts, weather patterns and menstrual cycles, and the results can mean migraines for anywhere from four hours to as long as three days for some women.”

During perimenopause, fluctuating estrogen levels can intensify existing headaches or cause new ones. And although menopause-related disturbances such as hot flashes have been an increasingly popular topic in clinical practice and research, migraine headaches have yet to receive the attention they deserve, Moloney said. Many women, she said, do not even know they are experiencing migraines.

“About half of all women with migraines don’t seek medical attention for what they think are just bad headaches, so they don’t get diagnosed and ultimately don’t get treated,” she said. “Health care providers should consider mentioning migraines when they examine women for other conditions.”

Moloney has begun a two-year pilot study to investigate the ways in which women take care of their migraine headaches and how the headaches affect their lives. Perimenopausal women who experience migraines use the Internet to answer questionnaires and participate in online chat groups. The study is being funded by the National Institute for Nursing Research/National Institutes of Health.

Contrary to most beliefs, a migraine is not just a bad headache. A headache is just one of the symptoms of migraine pain. Because migraines result from irritation of the nerves in the face, migraines can cause nasal congestion and facial pain. Migraine sufferers may also experience nausea, vomiting, vertigo, fatigue, sensitivity to light and sound, and flashing lights in their field of vision.

Moloney is particularly interested in the preventive measures women can take to prevent the triggers for migraines.

“Medications alone may not be enough,” Moloney said. “They don’t completely solve the problem, and they don’t work well for all people. Additionally, medications can’t be used all of the time because of their side effects.”

Moloney suggested that women with headaches monitor their lifestyles for conditions that trigger migraines. For example, they can try to decrease their stress levels or reduce their consumption of particular types of alcohol, such as red wine. Changes in the weather can also trigger migraine episodes for some women. In addition to avoiding triggers, herbs such as feverfew and vitamins like riboflavin are other preventive measures. But it is important to consult a health care provider before taking any supplements, Moloney cautioned.