What related health issues arise during perimenopause, and how can they be treated?


In addition to increased migraine, perimenopause can lead to other health issues in women that need to be treated simultaneously.


“So, I know for me it's so important during perimenopause, I have to take into account what else is going on in that woman's life? She has migraines that are getting worse. But is there depression? Is there anxiety? Is there endometriosis? And are there other health issues — hot flashes, night sweats, what can I do? Because when we do a preventive treatment, can we get a two-for, or a three-for? A great example in my practice: a very common patient in my practice would be a woman in her mid- to late 40s, who is perimenopausal, so her headaches are out of control. She has depression, and she has fibromyalgia. That's a difficult one. I could take a drug like duloxetine, which is Cymbalta, and it can help all three. Duloxetine is FDA approved for anxiety, depression, fibromyalgia, and can help hot flashes. So, again you can see why it's kind of complex, but it's also exciting because you can make a huge difference in someone's life. But when these women are perimenopausal, that's the woman I am going to see back every two to three months.

“And it's very dynamic. At least in my practice my patients have my email so, I tell them 'You're not stuck with what we do from this visit to the next.’ So I would encourage all woman headache sufferers to try to have a physician, it's dynamic. Either there's email, or there's phone calls, there's things in between visits, so you can fine-tune the treatment program. Because what works for one woman in her 30s may need to be an entirely different treatment program in her 40s and in her 50s.”


In addition to increased migraine attacks, women in perimenopause can also experience night sweats, hot flashes, depression, anxiety, and fibromyalgia. Dr. Susan Hutchinson encourages a dynamic and communicative approach between patient and doctor in order to treat some of these issues simultaneously with medication, adjusting as needed through the various points of a woman’s life.

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Susan Hutchinson, MD

Author - The Women's Guide to Managing Migraine
Orange County Migraine & Headache Center

Dr. Susan Hutchinson is a headache specialist and board-certified family practice physician. In February 2007, she founded Orange County Migraine & Headache Center, dedicated to serving patients with headache and mood disorders. Although she is not a psychiatrist, she has developed a special interest in treating mood disorders as well as headache. The mood disorders she treats include depression; anxiety; bipolar disorder; ADHD; and panic attacks. Dr. Hutchinson suffers from migraine headaches which gives her an empathy with her patients.

She felt such a calling to help patients with headache and mood disorders that she decided to specialize and devote her career to alleviating the suffering caused by both headaches and mood disorders. She lectures nationally on the subject of headache; has written dozens of articles for medical journals; participated in headache research projects and is very active in numerous professional organizations such as the American Headache Society and the National Headache Foundation.

She is the immediate post-chair of the Women’s Issues section of the American Headache Society after serving in the chair position for 5 years. Dr. Hutchinson is a dynamic and sought-after speaker. She speaks for community groups as well as professional groups. In 2010 she became the President of The Orange County Chapter of the California Academy of Family Physicians.