Does evening primrose oil help with headaches during perimenopause?

Evening primrose oil may offer some modest relief for headaches during perimenopause, particularly those linked to hormonal fluctuations and inflammation. The evidence is not definitive, but the biological mechanism is reasonably well understood and there is some research, mainly in premenstrual headache, to draw on. For migraine and severe headache, the evidence base is considerably weaker and established treatments are much better supported.

Headaches during perimenopause are often tied directly to estrogen fluctuations. Estrogen affects serotonin levels, blood vessel tone, and the body's inflammatory response, all of which influence headache frequency and severity. Many women who previously had mild premenstrual headaches notice they become more frequent or intense during perimenopause as hormone levels swing more unpredictably. These estrogen-withdrawal or estrogen-drop headaches, occurring when estrogen dips sharply, are among the most common and frustrating symptoms of this transition. The erratic hormone pattern of perimenopause, rather than the low estrogen of full menopause, often creates the worst headache periods.

Evening primrose oil contains gamma-linolenic acid (GLA), an omega-6 fatty acid that the body converts to dihomo-gamma-linolenic acid (DGLA) and then to prostaglandin E1, an anti-inflammatory compound. Critically for headache, this pathway competes with the production of prostaglandin E2, a pro-inflammatory prostaglandin implicated in the pain sensitization and vasodilation of headache episodes. By shifting prostaglandin balance toward the less inflammatory E1 type, EPO may reduce the intensity or frequency of prostaglandin-driven headaches. This is the same prostaglandin pathway that non-steroidal anti-inflammatory drugs (NSAIDs) target, though EPO works more gradually and more modestly.

Some research has shown EPO to be helpful for premenstrual headaches specifically, which share a hormonal mechanism with perimenopausal headaches. However, direct randomized controlled trials in perimenopausal headache populations are lacking. The evidence remains modest and largely indirect. EPO should not be viewed as a replacement for established headache treatments including magnesium, riboflavin, prescription migraine preventives, or hormone therapy, which have significantly stronger and more consistent evidence behind them for perimenopause-related headaches.

In EPO studies for perimenopausal symptoms, doses of 3,000 to 4,000 mg per day have been used, typically divided across meals to minimize GI side effects. Talk to your healthcare provider about the right dose for your situation. Some women begin with a lower dose and increase gradually over several weeks. Taking EPO consistently rather than only when headaches occur is likely more effective, since it works as a preventive rather than an acute treatment.

Evening primrose oil may interact with blood thinners and anticoagulants. It may also lower the seizure threshold, so discuss with your provider if you take any seizure medications. If you take blood thinners, antidepressants, or any prescription medications, check with your provider before adding this supplement. This is especially important if you use prescription migraine medications such as triptans, as interactions should be reviewed with a pharmacist or physician.

If you have or have had a hormone-sensitive condition such as breast cancer, endometriosis, or uterine fibroids, discuss evening primrose oil with your healthcare provider before using it.

Allow four to eight weeks of consistent use before evaluating any effect on headache frequency. Headache patterns shift slowly, and a single month is often not enough to assess a preventive supplement. Keeping a headache diary that tracks frequency, severity, duration, and any associated triggers such as menstrual timing, stress, or sleep disruption will give you and your provider much more useful information than memory alone.

Magnesium glycinate and riboflavin (vitamin B2) each have significantly stronger controlled trial evidence for reducing migraine and hormonal headache frequency than EPO does, so if you are weighing supplement options, these are often the better starting point for headache prevention. Some women find that combining magnesium with EPO addresses both the prostaglandin and the vascular components of hormonal headaches at the same time. If your headaches are clearly tied to estrogen drops in your cycle, hormone therapy is also worth discussing with your provider, since stabilizing estrogen levels can reduce the frequency of estrogen-withdrawal headaches substantially.

See your doctor promptly if you experience a sudden severe headache that is the worst of your life, a headache with visual changes, weakness, confusion, or difficulty speaking, or new headaches that are different in character from your usual pattern. These symptoms require urgent medical evaluation. Headaches that worsen progressively over several weeks, or that regularly wake you from sleep, also warrant investigation to rule out secondary causes.

The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log headaches daily so you can spot whether patterns shift over time and see whether headache frequency correlates with your cycle or other tracked symptoms.

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