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Research & Biology9 min read·July 2025

Endometriosis and Migraines: Understanding the Overlap

Endometriosis is a chronic, often painful condition where tissue similar to the lining inside the uterus grows outside of it, affecting the ovaries, fallopian tubes, pelvic lining, and other organs. Migraines are severe headaches often accompanied by nausea, vomiting, and sensitivity to light and sound. While these two conditions may seem unrelated, research shows a significant overlap between endometriosis and migraines, particularly among people assigned female at birth. Understanding this link is vital for comprehensive treatment and improved quality of life.

The numbers alone are striking. Endometriosis affects an estimated 1 in 10 people assigned female at birth — roughly 190 million individuals worldwide [1]. Migraine, meanwhile, is one of the most common neurological disorders globally, affecting more than 1 billion people and ranking as a leading cause of disability [2]. According to the Global Burden of Disease Study 2019, migraine is the second leading cause of disability worldwide and the leading cause among women aged 15–49 years [3]. When these two conditions coexist, the burden is not simply additive — it can be profoundly disabling.

The Connection Between Endometriosis and Migraines

Several studies have found a higher prevalence of migraines in individuals with endometriosis. A landmark 2012 population-based study published in PLOS ONE, using Taiwan's National Health Insurance Research Database, found that women with endometriosis were significantly more likely to suffer from migraine compared to controls (odds ratio 1.70; 95% confidence interval 1.59–1.82), and the association remained significant even after adjusting for age and hormone therapies [5].

More recent evidence strengthens this link. A 2025 systematic review and meta-analysis in The Journal of Headache and Pain pooled data from 13 observational studies totaling more than 331,000 individuals. It found that people with endometriosis had more than twice the odds of migraine compared to those without the condition (pooled odds ratio 2.25; 95% CI 1.85–2.72). The association was even stronger for migraine without aura (odds ratio 2.64; 95% CI 1.89–3.69) [4]. These findings suggest that the overlap is not a coincidence — it reflects shared biological pathways.

Hormonal Influences

Estrogen plays a central role in both endometriosis and migraines. Endometriosis is an estrogen-dependent disease: estrogen promotes the growth and inflammation of ectopic endometrial-like tissue, while progesterone resistance often allows estrogen-driven proliferation to continue unchecked [8]. Migraine, especially in women, is also tightly linked to hormonal fluctuations. The incidence of migraine is roughly three times higher in women than in men, and attacks frequently cluster around periods of estrogen withdrawal, such as the days before menstruation, the postpartum period, and perimenopause [6].

Menstrual migraine — attacks that occur between two days before and three days after the start of bleeding — is thought to be triggered primarily by the rapid drop in estrogen that precedes menstruation. A 2023 review in The Journal of Headache and Pain concluded that estrogen withdrawal is a key mechanism in menstrual migraine pathophysiology [7]. Because people with endometriosis often experience hormonal dysregulation, cyclical pain, and inflammatory flares during the same window of the menstrual cycle, they may be particularly vulnerable to hormone-related migraines.

Inflammation and Central Sensitization

Both conditions are linked to systemic inflammation and central sensitization — a heightened sensitivity of the nervous system to pain. In endometriosis, ectopic lesions trigger local and systemic inflammatory responses, releasing prostaglandins, cytokines, and other mediators that can sensitize nearby and distant nerves. Over time, this can lead to central sensitization, in which the brain and spinal cord amplify pain signals even after the original tissue injury has been treated.

Central sensitization helps explain why many people with endometriosis also report chronic pain conditions beyond migraine, including fibromyalgia, irritable bowel syndrome (IBS), and interstitial cystitis. A 2021 review in Frontiers in Reproductive Health described how peripheral and central sensitization in endometriosis can contribute to comorbid pain syndromes, blurring the lines between pelvic and whole-body pain [10]. Research on fibromyalgia and chronic fatigue syndrome has similarly highlighted how widespread pain and central nervous system sensitization can amplify symptom severity across multiple conditions [11].

The gastrointestinal overlap is especially notable. A 2022 systematic review and meta-analysis found that people with endometriosis have approximately three times the odds of developing IBS compared with healthy controls (odds ratio 2.97; 95% CI 2.17–4.06), with a pooled IBS prevalence of about 23% among those with endometriosis [9]. Because gut symptoms, pelvic pain, and migraine can all be modulated by the gut-brain axis and shared inflammatory signals, treating one condition in isolation may leave others undertreated.

Impact on Quality of Life

The dual burden of endometriosis and migraines can be debilitating. Both conditions can significantly impair daily functioning, mental health, and overall well-being. Chronic pain, fatigue, and the unpredictability of symptoms often lead to missed work, social isolation, and emotional distress.

When migraine and endometriosis occur together, the effect on productivity and daily life can be severe. Migraine alone is responsible for millions of lost workdays each year and is a top cause of years lived with disability among young women [3]. Endometriosis adds its own burden: painful periods, chronic pelvic pain, painful intercourse, bowel and bladder symptoms, and fertility concerns. For someone managing both, simple tasks — attending work, caring for family, or maintaining relationships — can become overwhelming.

Mental health is also affected. Studies have found higher rates of anxiety and depression among people with endometriosis and among those with chronic migraine. The combination of poorly controlled pain, diagnostic delays, and dismissive medical encounters can erode trust in the healthcare system and worsen psychological distress.

Treatment Considerations

Managing both endometriosis and migraines requires a multidisciplinary approach. Hormonal therapies — such as combined oral contraceptives, progestins, or gonadotropin-releasing hormone (GnRH) agonists — may help both conditions by stabilizing estrogen fluctuations. However, they must be tailored carefully: estrogen-containing contraceptives can improve endometriosis symptoms but may worsen migraine in some people, particularly those with migraine with aura, where estrogen is associated with increased stroke risk [6].

A comprehensive treatment plan may include:

  • Targeted migraine therapies: Acute treatments such as triptans, gepants, and anti-nausea medications, plus preventive options like beta-blockers, CGRP inhibitors, topiramate, or onabotulinumtoxinA for chronic migraine.
  • Endometriosis-directed therapy: Excision surgery with a trained specialist, hormonal suppression, pelvic floor physical therapy, and neuropathic pain modulators when appropriate.
  • Anti-inflammatory nutrition: Diets rich in omega-3 fatty acids, fiber, and colorful plant foods may support both conditions by reducing systemic inflammation and stabilizing estrogen metabolism.
  • Pain neuroscience education and physical therapy: Addressing central sensitization through graded movement, relaxation techniques, and cognitive strategies can help reduce pain amplification.
  • Mental health support: Counseling, support groups, and trauma-informed care can help patients cope with chronic illness, medical gaslighting, and isolation.

It is also crucial that healthcare providers recognize the co-occurrence of these conditions to avoid fragmented care. Patients should advocate for themselves by keeping symptom diaries, tracking menstrual cycles and headache patterns, seeking second opinions, and exploring treatment options that address both issues holistically.

Looking Ahead

The link between endometriosis and migraines underscores the importance of integrated care that considers the full scope of a patient's experience. Emerging research into shared genetic risk factors, neuroimmune cross-talk, and the gut-brain axis may one day lead to more targeted treatments. In the meantime, increased awareness and patient advocacy can help ensure those affected receive the comprehensive, compassionate care they deserve.

If you live with endometriosis and migraines, know that your symptoms are real, they are connected, and you deserve a care team that listens. Bringing a detailed symptom diary to appointments, asking about migraine screening, and requesting referrals to headache specialists or pelvic pain programs can be powerful first steps.

References

  1. World Health Organization. (2023). Endometriosis. Fact Sheet.
  2. World Health Organization. (2023). Headache disorders. Fact Sheet.
  3. Steiner, T. J., & Stovner, L. J. (2020). Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. The Journal of Headache and Pain, 21(1), 137.
  4. Colombo, G. E., Makieva, S., Somigliana, E., et al. (2025). The association between endometriosis and migraine: a systematic review and meta-analysis of observational studies. The Journal of Headache and Pain, 26(1), 82.
  5. Yang, M. H., Wang, P. H., Wang, S. J., Sun, W. Z., Oyang, Y. J., & Fuh, J. L. (2012). Women with endometriosis are more likely to suffer from migraines: a population-based study. PLOS ONE, 7(3), e33941.
  6. Vetvik, K. G., & MacGregor, E. A. (2017). Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. The Lancet Neurology, 16(1), 76-87.
  7. Do, T. P., Remmers, A., Schytz, H. W., et al. (2023). Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence. The Journal of Headache and Pain, 24(1), 131.
  8. Harada, T. (2013). Dysmenorrhea and Endometriosis in Young Women. Yonago Acta Medica, 56(4), 81-84.
  9. Nabi, M. Y., Nauhria, S., Reel, M., et al. (2022). Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses. Frontiers in Medicine, 9, 914356.
  10. Tu, F. F., Hellman, K. M., & Berkley, K. J. (2021). Peripheral, Central, and Cross Sensitization in Endometriosis-Associated Pain and Comorbid Pain Syndromes. Frontiers in Reproductive Health, 3, 729642.
  11. Vincent, A., Whipple, M. O., & Luedtke, C. A. (2016). Pain and other symptom severity in women with fibromyalgia and chronic fatigue syndrome. Pain, 157(1), 204-211.

Disclaimer: This information is for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult with qualified healthcare providers regarding your specific symptoms, concerns, and care options.