​When a woman’s body is transitioning into menopause, the accompanying hormone fluctuations can aggravate migraine. In many women, migraines can get better in the perimenopausal period but there can be a long period of time where migraine is transiently worse. Patients experiencing perimenopausal migraine have a number of treatment options, unless they have experienced a heart related event. Acute treatments like triptans or NSAIDs are not recommended for use in patients with heart disease. Preventative treatments, however, can be used for these patients. ​