Does ashwagandha help with headaches during perimenopause?

Headaches during perimenopause often intensify, change character, or appear for the first time, and the reasons are worth understanding before choosing a supplement approach. The two most common perimenopausal headache types are tension headaches driven by elevated cortisol and muscle tension, and hormonal migraines triggered by estrogen drops. Ashwagandha has a reasonable mechanism for the first type, since it lowers cortisol and reduces the physical tension component. For estrogen-drop migraines, the mechanism is more indirect, and the evidence is considerably thinner.

No clinical trials have tested ashwagandha specifically for perimenopausal headaches. The relevant research shows that ashwagandha reliably reduces cortisol and perceived stress, and that chronic stress is one of the most common headache triggers across headache types. A 2019 trial in Medicine found significant reductions in stress scores and cortisol with 240 mg per day of Sensoril extract. Tension headaches specifically are associated with elevated cortisol-driven muscle tension in the neck, trapezius, and pericranial muscles. By reducing HPA axis overdrive, ashwagandha may reduce the background tension that sets the stage for tension-type headaches. There is also some preliminary evidence that ashwagandha's GABA-modulating properties reduce anxiety, which is a known headache amplifier. Overall, the evidence is mechanistically plausible for tension headaches and essentially absent for migraines.

Perimenopause changes the headache landscape in ways that make understanding your headache type important. Hormonal migraines are triggered by estrogen withdrawal, which is why they classically occur in the days just before menstruation when estrogen drops sharply. During perimenopause, estrogen drops become more frequent, more severe, and less predictable, which is why migraines often worsen during this transition. Ashwagandha does not prevent estrogen drops or stabilize estrogen levels. For the stress-driven tension headache type, the picture is different: rising cortisol during perimenopause amplifies musculoskeletal tension and lowers the pain threshold, meaning the same daily stressors that once produced mild tension now produce a full headache. This is the category where ashwagandha's cortisol-lowering effect may be genuinely helpful.

Studies that showed cortisol and stress reductions used 300 mg of KSM-66 twice daily or 240 to 600 mg of Sensoril once daily. For headache prevention specifically, there is no established dose, but following the cortisol-reduction protocols from clinical trials is a reasonable starting point. Ashwagandha should be taken with food, as its fat-soluble compounds absorb better with a meal. Talk to your healthcare provider about the right dose for your situation, and mention whether your headaches have a clear hormonal pattern, since that information will help your provider determine whether a hormonal rather than supplement-based approach is more appropriate.

For tension headaches with a cortisol and muscle-tension component, ashwagandha may pair well with magnesium glycinate. Magnesium is one of the best-studied supplements for both tension headaches and migraines, with multiple trials showing reduced frequency and severity. Combining cortisol reduction (ashwagandha) with magnesium's effect on vascular and muscular reactivity addresses more pathways than either alone. If you take prescription medications, check with your provider before adding this supplement. For people on migraine medications, a provider conversation is especially important before adding anything that affects the nervous system.

For tension headaches with a stress component, some women notice fewer headaches or shorter duration within three to four weeks of consistent ashwagandha use. The full cortisol-lowering effect takes six to eight weeks to stabilize. If your headaches are primarily hormonal migraines triggered by estrogen fluctuations, you are less likely to see meaningful improvement from ashwagandha, and may notice little change. Managing expectations based on headache type is important here.

See a doctor if your headaches are new, thunderclap in onset, accompanied by visual disturbances, facial drooping, or weakness on one side. A headache that feels different from any you have had before always warrants same-day or emergency evaluation. Migraines with aura that have newly appeared during perimenopause need medical review because they carry specific cardiovascular considerations, particularly in relation to estrogen-containing therapies. If headaches are occurring more than 15 days per month, that is a frequency that warrants a neurology or headache specialist referral.

Keep a headache diary for one month before starting ashwagandha, noting frequency, severity on a 1 to 10 scale, time of onset, and cycle day. Continue for two months after starting. The PeriPlan app makes tracking cycle day easy, which helps you determine whether your headaches are perimenstrual (estrogen-drop pattern) or distributed throughout the cycle (more likely stress-tension pattern). The pattern tells you how much to expect from an adaptogen approach versus a hormonal or neurological one.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.