Fixes for 5 Headaches We Get in Midlife

Here are common reasons why headaches occur for women during midlife and how you can treat them.

1. Menstrual Migraine

These headaches, also called catamenial migraines, tend to happen during the first one or two days of menstruation in the years leading up to and during menopause.

“As women approach menopause, there’s an erratic rise and fall of estrogen, so you’ll actually see a peak in [certain kinds of] headaches,” says Kiran Rajneesh, M.D., a neurology and pain medicine physician at The Ohio State University Wexner Medical Center in Columbus.

And some post-menopausal women still get monthly headaches. “About one-third of women have a marked decrease in headaches after their periods stop, but many continue, even cyclically,” says McAllister.

One advantage of catamenial headaches is their foreseeable pattern. This makes them easier to treat with medications, says Rajneesh. He prescribes triptans, a family of painkillers particularly helpful with migraines. Frovatriptan is a triptan that has a longer half-life, which allows it to give longer release relief than some other options. “We can prescribe this and it will last about 26 hours.” There is some potential risk of high blood pressure, heart attacks, and strokes, though, so it is very important that any patient is given a thorough evaluation before being given a prescription for triptans.

He also suggests taking ibuprofen at the same time each month as a preventive measure. But if over-the-counter solutions don’t seem to be cutting it, you can see a doctor to find out if a prescription medication may help. For example, triptans can also be taken as a preventive measure.

2. Medication Overuse Headache

People who use over-the-counter medicine 15 or more days per month can develop “medication-overuse” headaches when their meds wear off. Middle-aged people are commonly affected, especially women, who were found to get medication-overuse headaches three times more often than men, according to the Cleveland Clinic. “Medication-overuse headache only occurs in migraine sufferers who—as the name implies—take too many acute meds,” says McAllister.

As we get older, adds Rajneesh, we may be more likely to take OTC medications to treat degenerative conditions, notably autoimmune disorders, which typically affect women at twice the rate they affect men. But relying too much on pain relief can have a boomerang effect. “The body gets used to certain levels of these medications, and when they drop, there’s a resurgence of headaches,” he explains.

If you do find yourself taking frequent rounds of pain medication, you may want to check in with your doctor to see if there might be a better option for managing your discomfort. “We don't want patients to take 15 of these ibuprofens a month,” says Rajneesh. “If you take more than that, you should be seeing a headache specialist, a neurologist, or a primary care physician. Because there are other classes of medications that people can take—one pill per day—that can prevent these headaches from coming on.”

3. Trigger Headache

People who tend to get migraines should pay attention to their sleep, eating, and exercise habits. Certain foods can trigger headaches, says Rajneesh. Exercise (or lack thereof) can do the same.

Rajneesh suggests that it may be helpful for women to add a “reasonable” amount of exercise (a couple of hours a week), assuming personal health conditions allow it, and to keep a “headache diary.” In the diary, record what you have eaten, how much exercise you have had, if you are hydrated, and symptoms you experience, then share this with your doctor(s).

“It’s useful for doctors to learn trends and possible offending agents,” says Rajneesh. These offending agents can differ from person to person; for example some might find caffeine helpful for a headache while others are triggered by it. Dark chocolate, that beloved treat, is also a common trigger, says Rajneesh. “There’s cocoa but there are also other amino acids in chocolate that trigger headaches.” Red wine can also serve as a trigger for headaches.

Cheese is another potential trigger. “In aged cheese, there is something called tyramine, which is a kind of protein that can trigger headaches,” Rajneesh says. Giving these items up can be difficult for many, though, which is why the diary is particularly useful in uncovering the personal foods or triggers that need to be eliminated without your having to eliminate them all.

4. ‘Pain in the Neck’ Headache

Believe it or not, sometimes, a pain in the neck is actually a type of headache, too. “As you get older, there’s more wear and tear around the neck, the muscles of which are connected to the head.” Such headaches, says Soma Mandal, M.D., an internist in Berkeley Heights, NJ can be caused by tight neck muscles or, among people with arthritis, limited range of motion in the neck. “Many with [cervicogenic headaches] complain about [neck pain] or that headaches are made worse by moving the neck,” she says, adding that the pain is often felt on one side of the head.

For this type of headache, posture adjustments or physical therapy might help you find relief. “In my practice, I usually address poor posture or any kind of ergonomic issue [such as] someone who uses a computer screen while [tensing] their neck muscles may have. Or, if there's no obvious cause, physical therapy can be helpful,” says Mandal. Other potential treatment options include prescription medications or anesthetic injections into the cervical joint.

5. Tension Headache

Stress can beget this type of headache, as well as migraine headache. “There is a strong association between stress and the immune and inflammatory systems,” says McAllister. “Stress changes [body] chemistry and releases proinflammatory cytokines,” which are molecules involved in the stress response.

“Tension headaches are mostly mild and not considered a medical condition,” he adds. “And they can exist with migraines in the same person.” People in midlife tend to have additional stress, concluded a 2020 study by researchers at Penn State University.

That kind of stress can lead to depression and other chronic-stress conditions that lead to more headaches. Rajneesh says that many chronic-headache patients have undertreated or underdiagnosed cases of depression or anxiety, and he asserts that mental health is a critical piece of healthcare. “Patients who are anxious or depressed are less likely to take medications on time, to exercise, and to have hobbies and they are also more likely to abuse substances,” he says. This leads to more headaches. “It's a vicious cycle,” he says. Additionally, constant stress can lead to alterations in your body, so that you become accustomed to a certain stress level. This can then cause a let-down headache when you are able to lower your stress level. Therefore, it is important to try and keep your stress level low to avoid any headaches, including let-down headaches.

“If you can lower your stress,” says McAllister, through exercise, meditation, social engagements, media breaks, or whatever else works for you, “that's the best thing you can do [for headaches].”

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