Migraines worsen during perimenopause for up to 75% of women — and 8–13% develop them for the first time with no prior history. The reason is specific: estrogen regulates CGRP, the primary pain-signalling molecule of the trigeminal nervous system. Stable estrogen suppresses it. Fluctuating estrogen allows it to surge — and the erratic hormonal swings of perimenopause produce the most frequent, most unpredictable attacks of any life stage. A 2026 American Headache Society posi