If I have migraine with aura should I use estrogen-containing birth control?
It is pretty common, especially among women, to get migraines. Usually a migraine is a severe headache that often only affects half the head and lasts from 1 - 72 hours. It is associated with nausea, vomiting, and sensitivity to light, sound, or smell.
Migraine with aura
Migraine with aura is a less common subtype of migraine in which you have some additional symptoms, usually before or after your migraine. These symptoms range from seeing sparks, bright dots, and zig zags to tingling on one side of the body or an inability to speak clearly, and they usually last 20-60 minutes.
If you have ever had this type of symptom, whether associated with birth control or not, it can mean that you may be at increased risk for stroke. You can even see how some of the symptoms almost seem like a mini-stroke. The risk is pretty small for most young healthy women but it is higher than normal.
Migraine with aura and estrogen
The risk of stroke goes up significantly any time there is more estrogen around (like pregnancy or from taking combination birth control). This risk is high enough that the official government recommendation of the CDC (Centers for Disease Control), the World Health Organization, and ACOG (the American College of Obstetricians and Gynecologists) recommend that you should not take estrogen containing birth control like combination pills, the birth control patch, or the birth control ring.
What can you use for birth control?
There are still a couple great options for birth control:
Some of the safest and most effective types of birth control like both the copper and the hormonal IUD are safe to use with migraine with aura. The birth control implant (Nexplanon) is also an excellent option.
These methods, collectively known as LARCs (long-acting reversible contraceptives) are super effective options and you can find out more about them by talking to your doctor or at BedSider. These require a doctor visit in-person for the IUD to be placed.
Depo-provera is a shot that contains only progesterone. It is given either in the muscle at a doctor’s office, or under the skin at home. The shot lasts 3 months and is a great option for people who want to have a lighter period or no period at all as often after the second or third shot your period goes away completely.
Progestin-only pills (POP), also called mini-pills, are a less common but great option. With the progestin-only pill you take an active pill every day, even during your period. Most people notice that for the first couple of months they may have a slightly heavier period, but after 6-9 months their periods are usually much lighter or go away. The progestin-only pill is safer for everyone, but especially may be a good option for women who smoke or have other risk factors.
Do I have migraine with aura?
If you are unsure if you have migraine with aura make sure to talk to your primary care doctor or a neurologist (brain doctor) who can help diagnose whether or not you have it.
Other risk factors
Other risk factors like smoking can significantly increase the risk of stroke for those with migraine with aura, and those without. If you are ready to quit smoking or to think about it make sure to talk to your doctor who can help you quit and stay quit.