Many factors can trigger a migraine attack, including hormonal changes. Taking hormonal birth control that contains estrogen, progesterone, or both may affect how often you experience migraine headaches. Some people experience an improvement in their symptoms with hormonal birth control, while others feel worse.

Hormonal birth control, including oral pills, skin patches, and vaginal rings, affects everyone differently. This article explains different types of hormonal birth control, the connection between hormones and migraine, how to navigate using hormonal birth control with — or for — migraine, and when to talk with your doctor.

The take-home message is that if you have migraine with aura, you should avoid estrogen-containing birth control and lean toward progestin-only or nonhormonal methods.

What Is Hormonal Birth Control?

Hormonal birth control is a type of medication that uses hormones to prevent pregnancy. There are different forms, including oral pills, injections, skin patches, vaginal rings, and intrauterine devices (IUDs).

Hormonal birth control may contain both estrogen and progesterone or only progesterone. Some types work by preventing the ovaries from releasing a fertile egg or by thinning the uterine lining. Other types thicken cervical mucus to prevent sperm from reaching the egg.

Long-acting hormonal birth control includes IUDs and hormonal implants. These methods last for years and are placed inside the body. They’re inserted either into the uterus or under the skin of the upper arm. Short-acting hormonal birth control includes pills, patches, shots, and rings. Birth control pills usually need to be taken every day. A shot may last three months.

How Hormones and Hormonal Birth Control Affect Migraine

Natural hormone fluctuations during your cycle, such as low estrogen levels, may trigger a migraine attack. Estrogen levels are usually lowest just before a menstrual period starts. Therefore, some people notice that their migraine attacks worsen right before or in the first few days of their period, or they experience a migraine headache only during this time, known as a menstrual migraine.

For people sensitive to this, taking hormonal birth control that contains estrogen may prevent migraine or make it less painful. One MyMigraineTeam member had success with this approach: “I have been taking birth control continually for over a year now, and it has helped with my migraine headaches, which are linked to my menstrual cycle.”

Hormonal birth control can make headaches better, worse, or have no effect at all. Starting a new prescription, in particular, may cause you to have more headaches at first but improve over time.

One MyMigraineTeam member wrote about birth control causing them to have more headaches: “I have had migraine headaches since my 20s, which is also when I started birth control. I didn’t have them at all when I was pregnant with my three kids and noticed a decrease while nursing. I recently had my IUD removed and am hoping for a decrease in headaches again.”

Talk with your healthcare provider if you notice your migraine attacks getting worse after starting or changing hormonal birth control. If you’re unsure if your headaches are affected by hormonal changes or birth control, consider keeping a headache diary. This may provide clues about when your headaches occur and if they follow a certain pattern each month.

Does the Type of Hormonal Birth Control Matter?

The type of hormonal birth control your healthcare provider recommends will depend on your migraine type, health history, and other factors.

People who don’t smoke and don’t experience migraine with aura may benefit from hormonal birth control that contains estrogen. It’s not safe for people with a history of migraine with aura and smoking to take hormonal birth control that contains estrogen. The estrogen in the medication could increase your risk of blood clots.

People who have migraine with aura experience nervous system symptoms before or during a migraine. An aura may involve vision changes, like seeing spots or flashing lights, or blurred vision. It may also cause tingling in your hands or face, or more rarely, weakness in one side of your body.

To determine if you have migraine with aura, think about if you experience any sensory changes before your headaches. About one-third of people with migraine have aura symptoms, such as vision changes, dizziness, numbness, or weakness. Tell your healthcare provider if you develop auras before your migraine attacks.

If you have migraine with aura, you may still be able to take birth control that contains progesterone alone. Birth control methods that contain the synthetic form of progesterone, known as progestin (pills or IUDs), don’t increase the risk of stroke. However, it’s important to note that progesterone-only pills can lead to migraine headaches by causing irregular spotting or bleeding.

It may take time to find the right hormonal birth control for you. One MyMigraineTeam member shared, “I’ve noticed that the birth control types that cause migraine headaches are the ones with estrogen. I had issues with the estrogen ones, so I switched to the progesterone type and haven’t had an issue.”

While hormonal birth control is an option for some people, it doesn’t work for everyone, as illustrated by another MyMigraineTeam member: “When I was younger, I was put on low-dose birth control to help control my migraine attacks, but I’m pretty sure it wasn’t helpful. I find that even now, if I use an estrogen cream, it can bring on an almost immediate migraine. In my experience, hormones have significantly increased my migraine attacks.”

Nonhormonal contraception, such as a copper IUD, might be preferred by some.

Keeping Estrogen Levels Consistent May Help

As mentioned above, if your migraine headaches tend to occur right before your menstrual period, they may be triggered by low estrogen levels. In this case, your healthcare provider may recommend continuous dosing with estrogen.

Most birth control pill packs include placebos, which are pills that don’t contain hormones. The last seven pills in a monthly birth control pill pack are usually placebo pills.

If low estrogen levels are a headache trigger for you, your doctor may recommend you skip the placebos and take the pills containing hormones every day, or use a constant delivery system such as a patch. This can keep your hormone levels consistent, prevent dips that may trigger a headache, and reduce the attack duration.

There are also low-estrogen pills available. These may be helpful because the placebo days will not cause your estrogen levels to decline as much as they would with a higher dose.

When To Talk With Your Healthcare Provider

If you suspect that your migraine attacks are connected to your hormone levels, talk with your healthcare provider. If you already see a gynecologist or neurologist regularly, make sure to bring it up at your next visit. It may be helpful to bring your headache diary to your appointment.

See your healthcare provider right away if you develop new migraine symptoms. While uncommon, it’s possible to experience a migraine-related stroke. People who experience migraine with aura are at an increased risk of migraine-related stroke.

A possible sign of a migraine-related stroke is an aura that continues for several hours. A typical aura lasts less than an hour. If you have one that goes on for hours, seek immediate medical care.

Join the Conversation

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