What Is The Relationship Between Migraine Aura And Birth Control Is Birth Control Risky For Women Who Experience Aura
About 20% of people with migraines experience aura, which is typically a warning that the headache itself is about to come on â€” although sometimes an aura occurs without the headache pain itself.
An aura can include unusual sensory changes such as seeing flashes of light, lines, zigzags or other visual changes, which is called a visual aura, unusual smells or sensations, and sometimes even numbness or weakness in their face, an inability to speak or understand words, and other unusual sensory symptoms.
Women who experience â€œmigraine with aura,â€? or any changes in vision before or with their headache, should not use any form of birth control containing estrogen, as the estrogen may increase the risk of stroke for these women.
But there are many safe birth control options for women who experience aura, including progestin-only pills , birth control shots, an intrauterine device , a contraceptive implant, or barrier methods like condoms, spermicides, a diaphragm, or a cervical cap.
But many women who suffer migraines without auras can safely use all birth control methods, including combination hormonal methods like birth control pills, the patch, and the ring.
Women Living With Migraine Should Speak To Their Healthcare Provider Before Beginning Hormonal Birth Control
Women experience migraine more often than men, says Dr. Huma Sheikh, Attending Neurologist at Mount Sinai School of Medicine in New York City, where she specializes in headache and vascular neurology. “Migraine is three times more common in women compared to men.” Other “studies show that women have an increased activation of parts of their brain that are involved with emotional connectivity,” says Dr. Sheikh.
Another key difference for women: oral contraception.
Oral contraceptives can affect women living with migraine differently. In general, most headache specialists are comfortable with allowing a patient with migraine to take hormonal birth control, says Dr. Sheikh. In some cases, oral contraceptives can be helpful in treating migraine. However, for some women, they may elevate their risk of stroke and cardiovascular disease, depending on their personal history. In addition, women with a history of migraine with aura also appear to be at an elevated risk of deep vein thrombosis . Estrogen-containing oral contraceptives also increase the risk of DVT, so in women who have a history of blood clots, a family history of blood clots, or previous spontaneous abortions, should be further evaluated before being placed on an estrogen-containing oral contraceptive pill.
Why Are Women With Migraine Who Take The Pill Or Use The Vaginal Ring Or The Patch A Special Case
The combined oral contraceptive pill , the contraceptive vaginal ring and the contraceptive patch contain the chemical oestrogen. They are all called ‘combined hormonal contraceptives’. They are generally used for 21 consecutive days, followed by a 7-day break .
Taking oestrogen causes you to have a slightly increased risk of having a stroke . If you have migraine without aura, you have a slightly increased risk of having a stroke compared with the normal risk. The increased risk of having a stroke is slightly higher in people who have migraine with aura.
If you take oestrogen and you have migraine the risks increase a little more, because now two risks are present.
- The combination of taking combined hormonal contraception plus having migraine without aura increases the risk of stroke slightly more than either alone.
- The combination of taking combined hormonal contraception plus having migraine with aura increases the stroke risk by a little more than this, multiplying it by 2 to 4.
This is still a very low risk, but it is an increased risk of something very serious. Doctors therefore advise against using combined hormonal contraception if you experience migraine with aura, as this is puts you at a small but unnecessarily increased risk of something very serious.
What Do I Do If My Migraines Change Or If I Start To Get Auras After Starting Oral Contraception
You should stop your oral contraception pill and contact your doctor for further advice.
In general, headache specialists recommend that if you are taking contraception and develop prolonged auras or new type of aura, or if you suddenly develop migraine with aura, you should stop taking the pill and see your family doctor urgently for further advice.
Ahs Doctors Discuss The Contraindication Of Contraceptives For Women With Migraine With Aura
Women are three to four times more likely to develop migraine than men, and when they do, they experience it quite differently. Research has found that women are more likely to have a primary headache disorder, which tends to more refractory attacks after an initial migraine. This may be due to sharp hormonal changes that take place during and after puberty.
Women often experience migraine due to changes in estrogen levels that take place during menstrual cycles, pregnancy and menopause. Dips in estrogen are most commonly associated with migraine onset, causing many patients to seek out hormonal balancing methods as a form of treatment.
“Oral contraceptives can be especially helpful in treating menstrual migraine,” said Huma Sheikh, MD, Assistant Professor of Neurology at the Mount Sinai School of Medicine in New York City. “However, this comes with the caveat of certain risks.”
This risk predominantly affects women with migraine with aura, due to their increased risk of stroke. Studies have shown that the use of oral contraceptives may increase that risk, as they already carry a small but notable increased risk of ischemic stroke. This has caused the use of oral contraceptives to be a long debated issue within the migraine community, for both their intended use and for migraine relief.
What Should You Do If You Think Your Birth Control Is Causing Your Headaches Or Migraines
If headaches start or worsen after you begin birth control, you should talk to the medical provider who prescribed it to you, being specific about when in your cycle your headaches occur .
There are a number of approaches that might successfully decrease or eliminate your headaches, especially if theyâ€™re a problem during the placebo part of the cycle.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Is It True That Migraine Is Associated With Stroke Can I Still Use The Contraceptive Pill
In general, women with migraine with aura are believed to have a 2 to 4-fold increased risk of stroke compared to women with migraine without aura. Many things might explain why migraine and stroke are related. Estrogen also increases the risk of stroke in young women. For this reason, contraceptives with estrogen are better avoided in women with migraine with aura. Luckily, there are many other available options.
It is understandably scary to think about this risk, but you should consider that the overall risk for a woman of reproductive age to have a stroke is about 1/10 000 per year. If you triple that, it increases it to about 3/10 000 per year which is still very small.
However, this rate does go up with every additional risk factors like age, high blood pressure, smoking, and diabetes. In women over 50, it appears that migraine with aura is not a risk factor anymore as other factors become more important.
Are There Contraceptive Pills That Are Better For Women With Menstrual Migraine
The drop in estrogen levels of the natural cycle is associated with migraines. We call those «menstrual migraines» and they affect 1/5 women with migraine. If you use a contraceptive pill with a sugar week that mimics the natural drop, it may trigger migraines as well. If you have migraines related to your menses, consider using a continuous oral contraception, either with no sugar pill or with a lower drop in estrogen dose. This is a well-studied approach for menstrual migraine.
How Do You Know If Your Birth Control Is Causing Your Headaches Or Migraines
If headaches or migraine attacks start or get worse when you start a new birth control method, after an increase in dosage, or improve after a reduction in dosage or stopping the birth control, it’s quite likely that birth control hormones are to blame.
It’s normal to experience an increased frequency and severity of headaches when you first start birth control, but this often improves with time. However, any neurologic symptoms, such as aura symptoms, or severe or debilitating headaches, are not a normal birth control side effect, and you should notify your healthcare professional if you experience them.
What Questions Should I Ask My Healthcare Provider About Menstrual Migraines
- Am I experiencing a menstrual migraine or another type of migraine?
- Should I change any of the medications I’m taking?
- What treatment do you recommend?
- What medications should I take?
A note from Cleveland Clinic
A migraine is more than a bad headache. Not only can menstrual migraines get severe, but women have reported that they can be even worse than a migraine that occurs when they’re not on their period. Talk to your healthcare provider about your symptoms. There are preventative measures and treatment options. A menstrual migraine might not be something you just have to “live with” every month.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.
If Birth Control Causes Migraine Symptoms To Get Worse Tell Your Doctor
There are instances where birth control may increase migraine symptoms, says Levitt.
“This can happen at first, and then it levels off. I usually will have a patient circle back within three months of starting a pill. We check blood pressure and talk about how they feel and what their migraine attack frequency is,” she says. “If it is increasing, then I usually switch them off, or we’ll change methods to a non-estrogen. I don’t want anyone feeling worse,” Levitt says.
Different people have different responses to changes in hormone levels, Levitt points out. “Menopause is a good example of that,” she adds. After menopause, the ovaries no longer produce much estrogen, but not all women with migraine respond the same way to that.
A 2018 study published in Current Treatment Options in Neurology found that although about 24 percent of women had headache improvement with menopause, for approximately 36 percent, it worsened. In this study “headache” included migraine disease as well as other headache types.
Speaking of birth control pill, Levitt says, “It’s relatively rare that migraine symptoms get worse with the combination pills.”
If that happens or if a woman develops migraine symptoms for the first time after starting oral contraceptives, she should consider that a red flag and discuss it with her healthcare provider, according to the American Migraine Foundation.
What Birth Control Side Effects Should I Expect While Taking The Pill
The hormones in birth control pills may cause side effects in some people. But this doesn’t happen to everyone — many people use the pill with no problems.
After starting the pill, some people may have:
Changes in your periods
The good news is that these side effects usually go away in 2-3 months. So if you just started the pill and you have side effects that bother you, try to stick it out and give your body a chance to adjust to the hormones.
Birth control shouldn’t make you feel sick or uncomfortable. If you still don’t like the way the pill makes you feel after a few months, talk with your nurse or doctor. They may suggest another brand of pill or a different birth control method. Some people try a few different types of pills or birth control methods before finding the right one for them.
And remember: if you stop taking the pill and don’t use another birth control method, you’ll be at risk for pregnancy right away.
The birth control pill has been around for decades, and millions of people have used it safely. Birth control pill side effects aren’t dangerous . You can always call a nurse or doctor, like the staff at your local Planned Parenthood health center, if you have any concerns while using the pill. And you can keep track of any potential side effects with our birth control app.
Hormonal Birth Control Could Carry Risk For Some Women With Migraine
For women with migraine with aura, however — in which the headache phase of a migraine attack is preceded by visual, sensory, or other nervous system symptoms — combination birth control pills may not be appropriate. In fact, the Centers for Disease Control and Prevention recommends complete avoidance of combination hormonal contraception for women with migraine with aura, regardless of age, because of studies showing an increased risk of ischemic stroke among women who have migraine with aura. There is no restriction for migraine without aura.
But not all experts agree that birth control pills are off-limits to women who have migraine with aura. Recommendations released by the International Headache Society in 2000, for example, contain no specific guidelines not to use oral contraceptive pills in women who have migraine with aura, according to a 2018 review in the journal Stroke.
According to Levitt, the mechanism of migraine is vasoconstriction in the arteries, mostly and in and around the brain. “If you have a tendency to form blood clots, you might have a higher incidence of stroke,” she says.
However, the absolute risk of stroke is low: According to an article , stroke related to migraine, called migrainous stroke, accounts for only 0.2 to 0.5 percent of all ischemic strokes. In the United States, that would mean about 2,000 to 4,000 out of the nearly 800,000 strokes that occur each year, according to CDC statistics.
Natural Treatments And Lifestyle Adjustments For Menstrual Migraines
Lifestyle treatments are always tricky to study, since they are hard to control and not as well-funded as pharmaceutical medicine.
Magnesium: There’s some evidence that magnesium can relieve migraine pain . In a small preliminary trial, participants took magnesium supplements three times per day starting from Day 15 of their cycle until the start of their next period . This treatment helped decrease the participants’ total pain and also improved their PMS symptoms . In a randomized control trial where participants received either a placebo or a drug containing magnesium, vitamin B2, and coenzyme Q10, the severity of migraines was lower among those taking the drug, though the number of days in which migraines were experienced was not statistically different from the placebo .
When Should I Seek Immediate Help Or Contact My Healthcare Provider
Schedule a visit with your healthcare provider if:
- The number or severity of your migraines increase, or your headache pattern changes.
- You’re experiencing new or different side effects.
- Your medications no longer seem to be working.
- Your headache comes on suddenly.
- You are experiencing the “worst headache of my life.”
- You have a headache after experiencing a head injury.
- You are having neurologic symptoms that you have never had before, including speaking difficulty, balance problems, vision problems, mental confusion, seizures, or numbing/tingling sensations.
I Am Thinking About Having A Baby Can I Just Stop My Contraceptives
Any woman considering a pregnancy should inform her family doctor. Pregnancy planning is also very important to discuss with your doctor because you may be on a medication that could harm the unborn baby, so planning for pregnancy is key to allow your doctor to switch you to a medication found to be relatively safer to use during pregnancy. .
1. Calhoun AH, Batur P. Combined hormonal contraceptives and migraine: An update on the evidence. Cleveland Clinic journal of medicine. 2017;84:631-8.
2. Warhurst S, Rofe CJ, Brew BJ, Bateson D, McGeechan K, Merki-Feld GS, et al. Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis. Cephalalgia : an international journal of headache. 2018;38:754-64.
Why Do Some Women Think Birth Control Can Cause Migraine Headaches
Another way to phrase this question: Can birth control cause migraines or does it just make you more susceptible if youâ€™re already prone to getting them?
When you start on new birth control itâ€™s not uncommon to have headaches while your body adjusts to the hormones. This often stops after the first two or three months, so don’t give up on birth control right away if you start getting migraines on the pill.
But some women do continue to get headaches after those first months. Some women are extra-sensitive to the hormones in birth control pills, especially the estrogen. These women usually do better on a low-dose pill, or a pill that contains only progestin. These progestin-only pills are often referred to as POPs or â€œmini-pills.â€?
Then there are other women who do fine for most of the month on combination methods that contain both estrogen and progestin, but then get headaches due to the drop in estrogen that occurs when they start the week of placebo pills, or between replacing the patch or ring.
For women who find headaches are triggered or worsened during the inactive pills, it often helps to switch to extended cycle pills, which only have a placebo week every three months instead of every month, or pills with a shortened hormone-free interval.
What Can I Do To Help Relieve The Symptoms Of A Menstrual Migraine
Do your best to figure out what makes your hormone headaches better or worse. For example, if light causes pain and you feel overheated, stay in a cool, dark room. Additional tips include:
- Keep your blood sugar levels up by eating small, frequent snacks. Never miss a meal.
- Learn relaxation techniques.
- Avoid too little or too much sleep, and keep a regular sleep pattern.
- Change your diet, if needed.
- Avoid stress when you can, and learn how to manage it when you can’t.
Uncovering A Dangerous Combinationmigraine With Aura And Estrogen
In college, I went on a birth control pill and took one brand or another for the next 10 years. By now, my childhood friend Jessica was in med school and called me one day in a panic.
“Do you still get migraines with aura?” she asked.
“Do you still take birth control pills with estrogen?”
“You need to get off those immediately. You could have a stroke.”
I thought she was being dramatic. There’s this thing called student doctor syndrome where med students think they or their loved ones have the diseases they’re studying. But, just in case, I mentioned it at my next gynecologist appointment.
Sure enough, I should not have been taking hormonal birth control with estrogen. I’d had a grandparent on each side die of stroke-related complications and still occasionally got migraines with aura. Jessica knew all of this family and personal health history and potentially saved my life. I was at high risk for a stroke now or in the future.
As it happened, I was visiting my gynecologist to talk about next steps before getting pregnant, so I simply stopped taking that form of hormonal birth control when my cycle ended and got pregnant quickly.
Does Taking Hormonal Birth Control Lead To Nutrient Deficiencies
What is not usually discussed is the fact that in order for the liver to metabolize birth control pills, it requires extra amounts of B-complex vitamins , vitamin C, magnesium and zinc. If you’re taking birth control for years on end, as are most women, you’re creating serious deficiencies of these crucial nutrients. Most women don’t realize this until after they have come off they pill and they’re contending with bouts of cystic acne, mood disorders, weight gain, sporadic periods and infertility.
Epidemiology Of Migraine And Combined Hormonal Contraceptive Use
Very recently, Mac Gregor reviewed the effects of currently available contraceptive methods in the context of the risks and benefits for women with migraine and non-migraine headaches and concluded that for the majority of women with headache and migraine, the choice of contraception is unrestricted. Indeed, the contraceptive method is unlikely to have an impact on headache, whereas migraine deserves accurate diagnosis and recognition of the impact of different methods on such condition.
Ive Got Migraine And I Want To Take The Combined Pill Is It Safe
For the majority of women CHCs are highly effective and safe methods of contraception. There can be some added health benefits such as reduced risk of womb, ovarian and bowel cancers, lighter menstrual periods and relief from premenstrual symptoms. Some women even take CHCs to help treat menstrual migraine. However, for a minority of women, including those who have migraine with aura, CHCs are associated with an increase in the risk of stroke. Fortunately, the actual likelihood of a stroke occurring in a young women with migraine with aura who takes the ‘pill’ is extremely low. It is also an avoidable risk since most contraceptives that do not contain oestrogen are at least as effective as CHCs and some are more effective.
So how great is the risk? Imagine a group of 100,000 women, all under 35, who do not have migraine and who don’t take CHCs. Only around one of those women is likely to have an ischaemic stroke within the next year. If the same group of women started on CHCs, of them are at risk of an ischaemic stroke within the next year. If all 100,000 women had migraine with aura and took CHCs, around 28 would be at risk. The risk of having a stroke is low even if you have migraine and take the pill and is likely to be even lower if you do not smoke or have high blood pressure. However, as the risk is directly related to the oestrogen in the CHCs, it can be avoided by using non-oestrogen methods of contraception.
Is It Possible For A Contraceptive Pill To Make Migraines Worse
Using an oral contraceptive pill or any hormonal treatment can either improve, worsen or not alter your migraine pattern at all. The impact is unpredictable. The worsening is typically seen when you are taking your sugar pills, but sometimes it is not that clear.
Consider using a headache diary to monitor attack frequency. Migraine has a natural tendency to fluctuate. It may take 2 to 3 months for the situation to stabilize.
Family physicians sometimes try to switch contraceptives to improve migraine but this is not a well-established approach. Anecdotes reporting migraine improvement after stopping oral contraceptives exist, but once again the result is difficult to predict.
Whats The Relationship Between Hormones And Headaches In Women
Hormone levels fluctuate over the course of the month and the menstrual cycle, which can trigger both tension-type and migraine headaches. According to the National Headache Foundation, about 60% of women with migraines experience more frequent or severe headaches around the time of their periods, when estrogen levels drop. Women not on birth control often get these â€œmenstrually related migraines” during the days before and the first three days of their periods.
Can Birth Control Cause Constipation Diarrhea Gas And Bloating
Do you know that the birth control pill actually messes with your gut bacteria? Yup, many women become estrogen dominant while taking hormonal birth control which can lead to an overgrowth of yeast. This overgrowth can cause constipation, diarrhea, gas/bloating – all of which are commonly diagnosed as IBS. I was plagued with horrible digestive problems for the four years I was on the pill and it took me ages to reverse the damage. And I see women on a daily basis whose gut problems all began while on the pill.
What Can I Do If I Think Birth Control Is Giving Me Headaches
Headaches are not usually a sign of a serious medical problem. However, it is important to see a doctor about any new symptoms.
A medical professional can diagnose the cause of the headaches and help a person to decide whether a certain type of birth control may reduce their frequency or severity.
When identifying the cause of headaches, it can help to keep a headache journal. The headaches may be unrelated to hormonal birth control, or they may result from sudden drops in estrogen, rather than being a side effect of a pill.
Keeping a record of headaches throughout a full menstrual cycle can give the doctor a complete picture of symptoms.
Very rarely, a headache can signal a life-threatening problem, such as a stroke. Seek emergency medical care for a headache that:
- is extremely severe and different from previous headaches
- occurs with confusion or loss of consciousness
- is accompanied by facial paralysis or a crooked smile
- occurs with weakness or trouble lifting both arms
For people who have migraines and an increased risk of stroke, additional symptoms may require emergency care. Ask a doctor about these.
Hormones are the body’s chemical messengers. When hormone levels change, the messages may be altered, or they may be received differently. This can cause various side effects.
Only certain people experience these side effects, and some find that they get better with time or dietary changes.
The most common side effects of hormonal birth control are: