Does DHEA help with headaches during perimenopause?

DHEA (dehydroepiandrosterone) is a precursor hormone that converts into estrogen and testosterone in body tissues. During perimenopause, erratic estrogen fluctuations are a well-documented trigger for headaches and migraines, and since DHEA is a building block for estrogen, there is a theoretical basis for asking whether it might help. The honest answer is that direct evidence for DHEA reducing headaches in perimenopausal women is very limited.

There are no published clinical trials specifically testing DHEA for headache prevention or relief in perimenopausal women. The connection between DHEA and headaches would have to work through its conversion to estrogen, since estrogen itself influences the trigeminal pain pathway, serotonin receptor sensitivity, and nitric oxide production, all of which play roles in migraine biology. Some research suggests that very low estrogen levels, rather than high ones, are more likely to trigger headaches, and that stabilizing estrogen can reduce headache frequency for some women. Whether DHEA's contribution to estrogen levels is sufficient or consistent enough to produce this effect is unknown. DHEA's conversion is variable and not directly controllable, so it would be a less reliable route to estrogen stabilization than forms of estrogen therapy designed for that purpose.

Hormonal headaches during perimenopause are largely driven by rapid estrogen drops rather than simply low levels. The periovulatory estrogen surge followed by a sharp decline, or the premenstrual drop in the late luteal phase, are the classic trigger windows. As cycles become irregular during perimenopause, these estrogen swings can become more dramatic and unpredictable. Cortisol elevation also lowers the headache threshold, and the DHEA-to-cortisol ratio shifts unfavorably with age and stress. DHEA supplementation might modestly support the cortisol-DHEA balance, which could have a secondary benefit on stress-type headaches, but this mechanism has not been studied in this context.

Studies in perimenopausal and postmenopausal women examining DHEA for hormonal outcomes have used oral doses of 25 to 50 mg daily. Vaginal DHEA (Intrarosa, 6.5 mg nightly) is FDA-approved for vaginal symptoms with minimal systemic absorption, making it unlikely to affect headache frequency either way. Because DHEA converts variably in different people, the same dose can produce different estrogen and testosterone effects in different women. Get your baseline DHEA-S level tested before starting. Self-dosing without knowing your baseline is risky. Talk to your healthcare provider about whether DHEA makes sense for your overall hormonal picture.

If you have or have had breast cancer, ovarian cancer, uterine cancer, endometriosis, PCOS, or uterine fibroids, do not use DHEA without discussing it with your healthcare provider first. At higher doses, androgenic side effects can occur: acne, oily skin, unwanted facial hair, scalp hair loss, and voice changes. If you are already using hormone therapy, adding DHEA without your provider's knowledge can alter your estrogen and androgen levels in ways that might worsen rather than improve hormonal headaches. Over-the-counter availability does not mean DHEA is safe to self-dose.

For perimenopausal headaches, strategies with more direct evidence include low-dose continuous estrogen therapy to reduce fluctuations (discussed with a provider), magnesium glycinate at doses studied at 400 mg daily for migraine prevention, riboflavin (vitamin B2), and keeping sleep consistent. Identifying and avoiding personal triggers like alcohol, certain foods, bright light, and dehydration also reduces frequency for many women.

See a doctor urgently about a headache that is the worst of your life, that came on suddenly like a thunderclap, that is accompanied by vision changes, confusion, weakness, or a stiff neck, or that is new in character and does not resemble your previous headaches. These symptoms can indicate a serious neurological event. For recurrent hormonal headaches, a neurology or headache specialist can offer prevention strategies beyond what supplements provide.

Keeping a headache diary that logs timing, severity, cycle phase, sleep, stress, and any dietary triggers is the most effective tool for identifying your specific pattern. The PeriPlan app lets you log headaches alongside cycle and lifestyle data daily, giving you and your provider a clear picture of your hormonal headache pattern. Download it at https://apps.apple.com/app/periplan/id6740066498.

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