Does Using Birth Control Affect Migraine?
We all know that migraine can be triggered or affected by almost anything under the sun. Stress? Check. Weather? Check. So is it possible for something as crucial as birth control affect migraine? We talk to neurologist Doctor Charisse Litchman, medical advisor to Nurx, to shed a bit more light on the interaction between birth control and our migraine.
So Dr Litchman, could you tell us a bit more about migraine and birth control?
While migraine does not discriminate on a person’s sex or age, they are often a female condition. One in four women will experience migraine, and they are often most frequent or intense during the period of a woman’s childbearing years. Of course, those are the same years when most women use contraception at some point, so if you experience migraine attacks, it’s important to understand how to choose a birth control method that’s safe, won’t make migraine worse — and hopefully will even make them better. Choosing a birth control method is certainly more complicated for people who experience pain and migraine!
Why Do Migraine Affect Women More?
The main reason that more women than men are impacted by migraine is related to fluctuating sex hormones, especially estrogen. The hormone plays a role in triggering migraine attacks and affecting the severity of migraine pain. According to the Migraine Research Foundation, boys develop headaches more often than girls prior to puberty. However, migraine becomes more frequent in girls after puberty (and the beginning of the menstruation cycle) as monthly hormone fluctuations begin and changes begin in their body.
About 60 percent of women experience more frequent and severe migraine attacks around their periods, called “menstrual migraine”. This is because of a big drop in estrogen that happens during the days leading up to and during the first three days of their periods. Over 2/3 of women have a decrease in migraine during their pregnancy period due to the stabilization of those estrogen fluctuations. The vast majority of postmenopausal women stop migraine at their age because their estrogen levels have dropped.
So What Is the Right Birth Control for Migraine?
For some women menstrual migraine are improved by taking a combination birth control, which contains the hormones estrogen and progestin. Combination birth control, including the pill, patch, and ring, keep estrogen levels steady throughout the month to stop an egg from being released. This decreases the pre-period estrogen plunge that can be a trigger — since there’s no estrogen surge and plunge, there is a smaller chance of a hormonal migraine happening.
However, it’s probably better for women with migraine to choose a monophasic pill, which contains the same level of hormones each day as compared to a triphasic pill, which varies the hormone levels throughout the month. Since fluctuation in your hormones seems to be a trigger, you want to choose a method that will limit those changes.
Some women feel good for most of the month on combination pills, but then get menstrual headaches during the week of placebo pills due to the drop in estrogen that occurs to allow a menstrual period — even though the plunge in estrogen isn’t as dramatic as when they’re not on the pill, it can still be a trigger for migraine. For these women, birth control may be even more effective if taken continuously to skip the period, so hormone levels stay steady all month long. To do this, you skip the week of placebo pills, or, if you use the birth control ring, you skip the ring-free week. To make it easier you can switch to an extended cycle pill, which only has a placebo week every three months instead of every month. Most gynecologists believe that it is safe to block periods and it may be a discussion worth having with the medical provider or doctor prescribing your birth control to see if this option is good for you.
What About Women who have Migraine with Aura?
When somebody who experiences migraine attacks also needs birth control, it’s incredibly important for the medical provider or doctor to know if they experience what’s known as migraine with aura. An aura is often a warning that a migraine is about to come on, although sometimes an aura occurs without the headache itself. The most common symptoms of aura are visual changes with flashing lights or zig-zag lines, vertigo, speech difficulty, or even numbness or weakness on one side of the body. About 20-30% of people with migraine experience aura, and aura is important as it guides which medication choices will be safe and effective for you.
Women whose migraine are accompanied by aura, or any changes in vision before or with their headache, should not use any form of birth control containing estrogen. Why? The hormone may increase the risk of stroke, heart disease or blood clots. But there are many safe birth control options for women who experience aura, including progestin-only pills (also called mini-pills), the birth control shot, an intrauterine device (IUD), or a birth control implant. Thankfully, all of these methods are estrogen-free and provide reliable protection. After all, we should all be able to choose if we want the possibility of pregnancy in our lives!
What if Birth Control Makes My Migraine Pain Worse?
The effects of hormonal birth control vary from woman to woman, making headaches worse in some and better in others. It’s not unusual to experience side effects for the first 3 or so months after you begin a new birth control, as your body adjusts to the hormones. For some women, headaches are a temporary side effect of switching to a new method. But some women do continue to get headaches after those first few months because they are 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.
However, in some cases getting headaches after starting birth control can be a sign that you should change methods. If after starting estrogen-containing birth control you get a migraine for the first time, if your headaches worsen significantly, or if you experience any neurologic symptoms, such as aura symptoms, be aware that those are not normal birth control side effects and that you should notify your medical team immediately. That’s a sign that you should switch to an estrogen-free form of birth control.
The Bottom Line
While combination birth control can improve migraine symptoms for some women, for others it doesn’t or isn’t adequate for migraine treatment. The most important thing to know is that there have been so many advances in migraine treatment in the last few years that you need to take advantage of. There are amazing new medications designed specifically to treat the root causes of migraine. You can take medication to stop migraine attacks quickly, to prevent them in the first place, or both. You do not need to suffer in silence as your mother or grandmother did.
Also know that high-quality migraine care is more accessible than ever. Through services like Nurx, you can get the help you need quickly, any time, without leaving your home or making an appointment. The medications will be delivered straight to your door. If you are suffering from migraine I really encourage you to demand the care you deserve — patients who do call it no less than “life-changing.”
Nurx offers both migraine treatment and birth control online. Simply share your health history and request care at your convenience and a medical provider licensed in your state will create your treatment plan and prescribe (if medically appropriate). Nurx bills insurance or offers affordable out-of-pocket prices, and sends medication to your door with free shipping.
About Dr. Litchman
Charisse Litchman MD, FAHS is a neurologist, headache specialist, and medical advisor to Nurx. She received her undergraduate degree at Wesleyan University and her medical degree at Yale School of Medicine. After completing her internship at Yale New Haven Hospital, she completed her neurology residency at Cornell-New York Hospital. She began a solo private practice in general neurology and became board certified in headache medicine in 2008. A former Assistant Professor of Clinical Neurology at Yale School of Medicine, Charisse has published articles in headaches and multiple sclerosis and edited the first textbook on a rare soft tissue tumor. Charisse is Chief Medical Officer at BeCare, a tech company that tracks the effectiveness of treatment of patients with Multiple Sclerosis. She has earned a certificate in Medical Editing and Writing from the University of Chicago. Charisse has three children and lives in Connecticut with her husband Mark and her two dogs.