Endometriosis roughly doubles the odds of experiencing migraines compared to people without the condition, according to a 2025 meta-analysis pooling data from 13 observational studies. The connection is not a coincidence or a matter of both conditions simply being common in women of reproductive age. Emerging genetic, inflammatory, and neurological evidence points to shared biological roots, and the overlap has real consequences for treatment decisions that many patients and clinicians still underappreciate.
How Strong Is the Evidence?
The most comprehensive look at this question comes from a systematic review and meta-analysis published in The Journal of Headache and Pain in 2025, which combined results from 13 studies and found that people with endometriosis were about two and a quarter times more likely to have migraines than those without (pooled odds ratio of 2.25). The association held up through multiple sensitivity checks, including one that excluded studies with a high risk of bias and another that counted only studies adjusting for hormonal therapy use.1PubMed Central. The association between endometriosis and migraine: a systematic review and meta-analysis of observational studies An earlier meta-analysis from 2020, working with fewer studies, estimated the association more conservatively at about one and a half times the odds.2PubMed. Endometriosis and migraine headache risk: a meta-analysis A large population-based study from Taiwan found that about 5% of women with endometriosis were diagnosed with migraine over the study period compared to roughly 3% of matched controls, and the relationship persisted after adjusting for other medical conditions.3PLoS ONE. Women with Endometriosis Are More Likely to Suffer from Migraines: A Population-Based Study
A smaller clinical study found an even starker divide: nearly 45% of women in the endometriosis group met the diagnostic criteria for migraine, compared to about 27% of controls.4Journal of Endometriosis and Pelvic Pain Disorders. Association between endometriosis, headache, and migraine That higher percentage likely reflects the fact that these were patients presenting at a clinic rather than a random sample of the population, but the gap between groups is consistent across study designs. Whether researchers looked at insurance databases, clinical cohorts, or population surveys, the pattern recurred: endometriosis and migraine cluster together far more than chance would predict.
Migraine Without Aura in Particular
One detail that stands out in the data is that endometriosis is most strongly linked to migraine without aura, which is the more common type involving moderate-to-severe head pain, nausea, and light sensitivity but not the visual disturbances or sensory warning signs that precede a migraine with aura. The 2025 meta-analysis reported an odds ratio of about 2.64 for migraine without aura in people with endometriosis, while the association with migraine with aura was statistically uncertain.1PubMed Central. The association between endometriosis and migraine: a systematic review and meta-analysis of observational studies
This distinction matters for a practical reason. Migraine without aura is the subtype most tightly linked to hormonal fluctuations, particularly the drop in estrogen that occurs around menstruation. Since endometriosis is itself an estrogen-dependent disease, the preferential association with migraine without aura supports the idea that shared hormonal sensitivity is a major driver. It also has treatment implications, which we will get to below.
What Biology Do They Share?
Saying that two conditions are associated does not explain why. Researchers have been working through several overlapping biological mechanisms, and the picture is more interesting than “hormones affect everything.”
Genetic Overlap
Genome-wide studies have found that endometriosis and migraine share genetic architecture to a meaningful degree. One analysis reported a genetic correlation of 0.38 between the two conditions, meaning that the genetic variants influencing risk for one also tend to influence risk for the other. Gene-based testing identified 17 genes shared between endometriosis and migraine, and the biological pathways enriched in both conditions included inflammatory signaling cascades that are well known in pain research.5Human Reproduction Update. Insights from Mendelian randomization and genetic correlation analyses into the relationship between endometriosis and its comorbidities A separate analysis identified three specific genes that reached significance only when data from endometriosis and migraine were combined, suggesting these genes contribute to both conditions simultaneously rather than to one or the other.6PubMed Central. Shared Molecular Genetic Mechanisms Underlie Endometriosis and Migraine Comorbidity A large study in Nature Genetics confirmed significant genetic correlations between endometriosis and migraine alongside several other pain and inflammatory conditions.7Nature Genetics. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions
What this means in plain terms is that the tendency to develop both endometriosis and migraine is partly built into the same stretches of DNA. If you have endometriosis and also experience migraines, it is not that one condition is “causing” the other in a simple chain of events. They share underlying biological wiring.
Inflammation and Pain Sensitization
Both endometriosis and migraine involve chronic inflammation and a process where the nervous system gradually turns up its sensitivity to pain. In endometriosis, tissue similar to the uterine lining grows outside the uterus, provoking an ongoing inflammatory response. In migraine, inflammation of the membranes surrounding the brain and activation of the trigeminal nerve pathway produce head pain. A recent opinion article in Trends in Molecular Medicine proposed that compromised blood flow at the level of tiny blood vessels, combined with inflammation, could be a common driver of multiple chronic pain syndromes, linking the oxygen-poor, inflamed microenvironment around endometriosis lesions to processes that also occur during migraine attacks.8PubMed. Nociceptor-to-macrophage communication through CGRP/RAMP1 signaling drives endometriosis-associated pain and lesion growth in mice – Section: Abstract
Central sensitization, where the spinal cord and brain amplify pain signals even when the original stimulus is mild, appears to be active in both conditions. A study of women with chronic pelvic pain found that over two-thirds had a history of migraines, and those with migraines showed more signs of sensitization overall.9PubMed Central. Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain This helps explain why many people with endometriosis develop widespread pain sensitivity that extends beyond the pelvis, manifesting as headaches, jaw pain, and muscle tenderness in areas far from any endometrial lesion. Research into the neuropsychiatric dimensions of endometriosis has highlighted that this central sensitization is driven by changes in how the brain processes pain signals, involving glial cell activation and neuroplasticity, and that coexisting migraine worsens the overall disease burden yet frequently goes under-treated.10Academia Mental Health and Well-Being. Neuropsychiatric and cognitive manifestations of endometriosis: insights into the ‘endometriosis brain’
Endometriosis, Migraine, and the Overlap With Other Pain Conditions
The U.S. National Institutes of Health classifies both endometriosis and migraine as Chronic Overlapping Pain Conditions, a group of disorders that tend to coexist in the same person far more often than random chance would explain.11PubMed. Endometriose und chronische überlappende Schmerzsyndrome Other conditions in this cluster include fibromyalgia, chronic fatigue syndrome, irritable bladder, temporomandibular disorders, and chronic tension headache. The theory is that once the central nervous system becomes sensitized by one chronic pain source, additional pain conditions are more likely to develop or worsen.
A cross-sectional survey confirmed the pattern: a quarter of women with endometriosis reported three or more overlapping pain conditions, compared to 12% of women without endometriosis. Those with endometriosis had higher rates of fibromyalgia, chronic fatigue syndrome, and temporomandibular disorder in addition to migraine.12PubMed Central. Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey If you have endometriosis and migraines, it is worth paying attention to other symptoms too, because what feels like a collection of unrelated complaints may actually be one sensitized nervous system expressing itself in different areas of the body.
The Headache Isn’t the Only Extra Symptom
Migraine gets the most research attention because it is a well-defined, diagnosable condition, but the broader symptom picture for people with endometriosis extends well beyond pelvic pain and headaches. A multi-center study comparing women with endometriosis to controls found significantly higher rates of a wide range of complaints. About a quarter of women with endometriosis reported frequent migraine or headache, compared to roughly 12% of controls. But the study also documented higher rates of back pain, neck tension, sleep disturbances, mood swings, digestive problems, and even teeth grinding among those with endometriosis.12PubMed Central. Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey The standout figures included neck tension in about half of the endometriosis group versus a third of controls, and sleeping disorders affecting a third of those with endometriosis compared to about 12% without.1PubMed Central. The association between endometriosis and migraine: a systematic review and meta-analysis of observational studies
This matters because many people with endometriosis seek care piecemeal: a gynecologist for pelvic pain, a neurologist for migraines, a gastroenterologist for digestive symptoms, a therapist for mood issues. The conditions get addressed in silos, and nobody puts the full picture together. Understanding that these symptoms tend to cluster and share underlying mechanisms can change how you advocate for your own care.
The Hormonal Treatment Dilemma
Here is where the overlap between endometriosis and migraine creates a genuine clinical headache (no pun intended). The first-line medical treatment for endometriosis pain is typically hormonal: progestins or combined oral contraceptives that suppress estrogen fluctuations and slow the growth of endometrial-like tissue. The problem is that combined oral contraceptives, which contain both estrogen and progestin, can make migraines worse in some women. This is a recognized phenomenon, not a rare side effect, and it is particularly concerning in women with migraine with aura because combined hormonal contraceptives in that group carry an increased risk of stroke.13PubMed. Comparing treatments for endometriosis-related pain symptoms in patients with migraine without aura
For women with endometriosis who also have migraine without aura, progestin-only therapies, GnRH agonists, and other non-estrogen hormonal options avoid this particular conflict. But the treatment decision requires awareness of both conditions, and many patients report that their migraine history is not considered when endometriosis treatment is prescribed. If you have both conditions, it is worth explicitly raising the migraine issue with your prescribing clinician rather than assuming it has been accounted for.
CGRP and a Promising Shared Target
One of the more exciting developments in recent years involves a molecule called CGRP, or calcitonin gene-related peptide. CGRP has been central to migraine treatment for the past decade. It is a signaling molecule released by pain-sensing nerves that dilates blood vessels and drives inflammation in the membranes around the brain. Drugs that block CGRP or its receptor are now FDA-approved for migraine prevention and acute treatment, and they represent the first class of drugs developed specifically for migraine in decades.
What caught researchers’ attention is that CGRP also appears to play a role in endometriosis. A 2024 study in Science Translational Medicine used a mouse model to show that pain-sensing nerves in the pelvis release CGRP in response to endometriosis lesions, and that this CGRP signals to immune cells (macrophages) in a way that promotes both pain and lesion growth. When the researchers treated the mice with FDA-approved CGRP-blocking drugs already used for migraine, not only did pain decrease, but the endometriosis lesions themselves shrank.14PubMed. Nociceptor-to-macrophage communication through CGRP/RAMP1 signaling drives endometriosis-associated pain and lesion growth in mice
This is still preclinical work, and effects in mice do not automatically translate to humans. But the finding raises the tantalizing possibility that anti-CGRP drugs could address both migraines and endometriosis-related pain in the same patient, without the hormonal complications that currently make treatment planning so tricky. Clinical trials in humans have not yet been published, but the biological rationale is strong enough that several research groups are pursuing this question. For patients who already take a CGRP-blocking medication for migraine, it will be worth watching whether the endometriosis research catches up.
When Headaches Start or Change Around Your Cycle
Many people with endometriosis notice that their headaches follow a menstrual pattern, intensifying in the days just before or during their period. This is consistent with menstrual migraine, a recognized subtype triggered by the estrogen withdrawal that occurs in the late luteal phase. Because endometriosis itself flares with the menstrual cycle, both pelvic pain and headache can peak at the same time, creating a miserable few days each month.
If your headaches are tightly synchronized with your period, that pattern is itself useful information. It suggests estrogen withdrawal as a major trigger, which can guide treatment choices. Continuous hormonal regimens that suppress the menstrual cycle entirely, rather than cyclical pills with a placebo week, can reduce both endometriosis symptoms and menstrual migraine by eliminating the hormonal dip that triggers both. Progestin-only options, hormonal IUDs, and continuous-dose combined pills (for those without migraine with aura) are all strategies that gynecologists and neurologists use for this specific situation. Again, the key is that both conditions are on the table during the treatment discussion.
What to Tell Your Doctor
If you have endometriosis and are experiencing headaches you suspect might be migraines, there are a few things worth communicating clearly. Track whether your headaches correlate with your menstrual cycle. Note whether they are one-sided, pulsating, and accompanied by nausea or light sensitivity, as these features point toward migraine rather than tension headache. Mention any aura symptoms, because that distinction affects which hormonal treatments are safe for you. And if you are already being treated for endometriosis with a combined oral contraceptive and your headaches have worsened since starting it, that is a finding your clinician needs to hear.
The research increasingly shows that endometriosis is not just a pelvic disease. It involves systemic inflammation, changes in how the brain processes pain, and genetic wiring that overlaps with migraine and other chronic pain conditions. Treating these conditions in isolation, or dismissing the headaches as unrelated stress, misses the biology and leaves treatable symptoms on the table.
Are Tension Headaches Part of the Picture Too?
Most of the published research focuses on migraine specifically because migraine has clear diagnostic criteria and a well-studied biological basis. But tension-type headaches are also classified among the Chronic Overlapping Pain Conditions alongside endometriosis.11PubMed. Endometriose und chronische überlappende Schmerzsyndrome The neck tension reported by about half of women with endometriosis in clinical surveys is a common trigger for tension headaches, and central sensitization can lower the threshold for both types of headache simultaneously. If you have endometriosis and frequent headaches that feel more like a band of pressure around the head than a pounding one-sided pain, the same underlying sensitization process may be relevant, even though the formal research base is thinner for that specific combination. The practical takeaway is the same: mention it, track it, and make sure your care team sees the full pattern rather than each symptom in isolation.