Does the birth control pill worsen migraines?
Q: I get migraine headaches and have been told that I shouldn’t take birth control pills. Is that true?
A: The answer depends on the type of migraine you get.
Eighteen percent of American women do suffer from migraine headaches. These often begin at puberty and diminish after menopause. Most female “migrainers” find that their headaches get worse just before or during their period when their estrogen levels decline, a known instigating factor for migraines. These are aptly called menstrual migraines.
Quite often, women confuse tension headaches with migraines. The diagnostic criteria for a migraine are:
- A headache attack that lasts 4 to 72 hours (when untreated)
- Pain on one side of the head, often accompanied by nausea and vomiting
- The pain gets worse with light, noise or routine physical activity
In contrast, tension-type headaches usually occur on both sides of the head and the pain is non-pulsating, does not induce nausea or vomiting and is not aggravated by activity, light or sound.
There are two types of migraine: one that occurs with aura (about 10 percent to 30 percent of migraines) and one that occurs without.
“Aura” is a nice sounding name for a very disturbing neurological occurrence in which your vision is blurred by flickering lights, spots or lines, or you may even temporarily lose your sight. You may also have an unpleasant feeling of pins and needles or numbness in parts of your body, and in some cases, develop some difficulty talking. If aura occurs, it usually begins five to 60 minutes prior to the onset of headache pain.
The concern about the use of birth control pills among migraine sufferers has to do with the possibility of an increased risk of stroke. In general, the risk may be minimally higher in all women who suffer from migraines (including those who don’t use birth control pills) especially if their migraines are accompanied by aura. (I should note that women who suffer from migraines and also smoke one or more packs a day have a tenfold increased risk of stroke.)
The alleged link between pill use and stroke is a controversial one. Many physicians, including myself, will suggest that patients who don’t smoke, are under 35 and tend to have menstrual migraines use “extended dosing” of birth control pills to prevent the menstrual estrogen decline that may lead to a migraine. Extended dosing means a patient takes the active portion of the birth control pill pack for three or more months, so that she doesn’t experience a month-end decline in her estrogen level (and subsequent period), and hence thwarts migraine development. Of course, if pill use results in an increase in the frequency or severity of her headaches, I tell her to stop.
Another trick that I and many of my colleagues use to prevent the menstrual estrogen “down” is to add an estrogen patch on the week off the pill. I’ve also suggested this estrogen “patch–up” just before a period for women who suffer from menstrual migraines and who are not on the pill.
Yet, having given you an okay to use birth control pills — suggesting you use it on a three-month-on, one-week-off basis — I have to add a restriction supported by both the American College of Obstetricians and Gynecologists and the World Health Organization: If you have a migraine with aura, don’t use birth control pills before consulting a headache specialist. And under no circumstances should you take birth control pills if you smoke and have migraines of either type. If you suffer from tension-type headaches, however, there is no contraindication to use of birth control pills.
Dr. Reichman’s Bottom Line: If you get migraines without aura, especially during your period, it’s okay to try using birth control pills for pregnancy prevention. Your headaches might even improve with extended dosing. However, if your headaches get worse and/or your migraines are unusual or are accompanied by aura, don’t use the pill and see a neurologist or a headache specialist.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.