Migraine and birth control
Hormones and migraine
Hormonal changes are a common migraine trigger, so if you often have a migraine attack just before or during your period, you’re not alone. It is thought that migraine attacks can be triggered by a drop in levels of the hormone oestrogen, which happens just before your period.
Keeping a headache diary can help you work out if your period is triggering your migraine attacks. You can also speak to your GP about how to manage your hormonal migraine attacks in the way that’s best for you.
Migraine and contraception
The link between migraine and hormones means we need to think about migraine when choosing contraception. Contraception is the methods we can use to prevent pregnancy, like the pill, the coil and the implant.
Migraine and the pill
There are two types of contraceptive pill, the combined pill and the progesterone-only (or mini) pill. The combined pill contains the hormones oestrogen and progesterone, and the mini pill only contains progesterone.
Lots of people with migraine can take either pill, but if you have migraine with aura you should not take the combined pill. This is because of a very slight increased risk of stroke when taking the combined pill. If the combined pill is not right for you, then you can take the progesterone-only pill which is suitable for people with migraine with aura.
Some women find that the hormones in contraceptive pills can trigger migraine attacks or make their migraine worse. The progesterone-only pill can also cause irregular bleeding which can sometimes lead to headaches.
If you start taking the pill and notice your migraine getting worse, you should speak to your doctor about trying something different.
If you are taking the combined pill and start to experience migraine attacks with aura, you should stop taking it. Use another type of contraception like condoms and speak to your doctor.
How do I know if I have migraine with aura?
About a third of people with migraine experience aura. It involves sensory changes that can feel quite strange. They happen before the main migraine attack symptoms like head pain and feeling sick begin and usually last no more than an hour.
Migraine aura usually affects sight, but it can also make it hard to think, speak or string words together. You might have blurred vision, see flashing lights, sparkles, wavy lines or spots. You may also have blind spots and not be able to see properly. You may feel dizzy, have pins and needles, or feel numb or weak.
If you have any of these symptoms when you have a migraine attack, it’s likely you have migraine with aura and should not take the combined pill. You should see your doctor to get a diagnosis and find out the best contraceptive option for you.
Other birth control options
Aside from the pill, there are various options when it comes to contraception. Some contain hormones and some do not.
A contraceptive implant is a tiny plastic rod that is placed under the skin at the top of your arm. It releases a manmade version of progesterone, called progestin, and stops you becoming pregnant for three years. It is safe for women with migraine, including migraine with aura.
The contraceptive injection usually lasts for 13 weeks, although one type (Noristerat) lasts for eight weeks. It does not contain oestrogen, so it is safe for women with migraine with aura.
You might have heard this referred to as the coil. It is a small T-shaped device that is placed inside the uterus by a nurse or doctor. It slowly releases the hormone progestogen and lasts for three to five years. The IUS is safe for women with migraine with aura.
This is a small plastic ring that you place inside your vagina. It works by releasing the hormones oestrogen and progestogen. You leave it in for 21 days at a time followed by a 7 day break. Because it releases oestrogen, you should not use the ring if you have migraine with aura.
The contraceptive patch is a sticky patch you apply to your skin. You can leave a patch on for a week before changing it. You wear one patch each week for three weeks before taking a week off. The patch releases the hormones progestogen and oestrogen, so you should not use it if you have migraine with aura.
Other types of contraception like male and female condoms and diaphragms/caps do not affect your hormones and therefore will not affect your migraine. You can find out more about birth control options and who can use them on the NHS website.
If you’ve had unprotected sex you may want to consider taking emergency contraception (the morning after pill) to avoid becoming pregnant. You usually take it within 72 hours of having sex and it is most effective within 12 hours. It only contains the hormone progesterone which means it is safe to take if you have migraine with aura.
Can contraception help my migraine?
For some people, the combined contraceptive pill or the contraceptive injection can help to reduce migraine attacks that happen before your period. Many women experience premenstrual syndrome (PMS) before their period – common symptoms include mood swings, feeling tired, sore breasts, headaches and spotty skin. If your migraine worsens just before your period it may be associated with PMS and contraception may improve it.
Your doctor will be able to advise you on whether it might help. If you have migraine with aura, you should not take the combined pill. However, the injection is safe for you to use.