Does melatonin help with headaches during perimenopause?

Headaches, including migraines, often worsen during perimenopause because of the erratic fluctuations in estrogen levels. Estrogen affects serotonin signaling, blood vessel tone, and pain sensitivity, so as estrogen swings unpredictably, many women find headaches become more frequent, more severe, or change in character. Melatonin has been studied for migraine specifically, and the evidence here is more direct than it is for most other perimenopausal symptoms.

Melatonin is produced by the pineal gland and regulates the circadian rhythm. During perimenopause, its production declines alongside estrogen. Research by Toffol et al. (2014) confirmed lower melatonin levels in perimenopausal women correlating with sleep disturbances. Sleep deprivation is a well-established trigger for headaches and migraines, so by improving sleep quality, melatonin addresses one concrete headache driver.

Beyond sleep, there is clinical evidence specifically examining melatonin for migraine prevention. Peres et al. (2004) conducted a trial in which migraine patients took 3 mg of melatonin nightly for three months. The researchers found that migraine frequency decreased by at least 50 percent in approximately half of participants, and mean headache frequency, intensity, and duration all decreased compared to baseline. While this was an open-label study without a placebo control group, the findings are consistent with plausible mechanisms: melatonin may act on hypothalamic pain-processing pathways, regulate serotonin availability, and reduce the trigeminovascular inflammation associated with migraine attacks.

Melatonin's anti-inflammatory properties support this. Rossignol and Frye (2011) reviewed evidence that melatonin inhibits NF-kB-mediated inflammatory signaling, which plays a role in neurogenic inflammation during migraines. Melatonin also has antioxidant activity that may help protect against oxidative stress in neural tissue.

For tension-type headaches and other non-migraine headaches during perimenopause, the evidence is less specific. Improved sleep quality reduces overall pain sensitivity and headache frequency in general, so melatonin's sleep benefits may extend to tension headaches in women whose headaches are partially sleep-driven.

Bellipanni et al. (2001) noted general wellbeing improvements in perimenopausal women taking 3 mg of melatonin nightly for six months. Reduced headache burden was not explicitly reported, but improved sleep and mood are themselves associated with lower headache frequency.

Research on melatonin for migraine and headache has most commonly used doses of 3 mg taken at bedtime. Research by Zhdanova et al. (2001) found that 0.3 mg was effective for sleep specifically in middle-aged women without next-morning grogginess. For headache prevention, the migraine studies have used the higher 3 mg dose. Talk to your healthcare provider about the right dose for your situation, as individual factors including other medications and health conditions matter.

Safety: melatonin is generally well tolerated for short-term use. Higher doses can cause next-day drowsiness. It may interact with blood thinners, immunosuppressants, and some diabetes medications. Women with autoimmune conditions should use it under medical guidance.

If you track your cycle phase and headache patterns in PeriPlan, you may be able to identify whether your headaches cluster around specific hormonal moments (such as the drop in estrogen just before a period or during an irregular stretch). This information is valuable for your provider when deciding whether hormone management or preventive supplements like melatonin are the more appropriate approach.

When to see a doctor: Any headache that is the worst of your life, comes on suddenly like a thunderclap, is accompanied by neurological symptoms such as vision changes, weakness, numbness, or speech difficulty, or follows a head injury requires emergency evaluation. These are potential signs of serious conditions that are unrelated to perimenopause. Additionally, if your headaches have changed significantly in pattern, frequency, or character, a medical evaluation is warranted to rule out other causes before attributing the change to hormonal shifts. If migraines are occurring frequently enough to require treatment on more than two days per week, speak with your provider about prescription preventive options.

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