Some Birth Control Doesn’t Mix with Migraine: What You Need to Know

Hormonal fluctuations caused by some types of birth control can trigger migraine, though in some cases, birth control may help. Those with aura may also be at increased risk of stroke when taking certain types of oral contraceptives.

Migraine attacks can happen to anyone, regardless of sex or gender. However, research shows that women experience them more than men.

Menstruating people may seek out oral birth control containing synthetic hormones to significantly reduce the likelihood of becoming pregnant. But what if they experience migraine?

Can contraceptives and migraine mix? Read on to get expert tips and insights on migraine and birth control.

Join the free Migraine community!

Connect with thousands of members and find support through daily live chats, curated resources, and one-to-one messaging.

Sign up

What’s the link between migraine and hormonal birth control?

According to research from 2022, women are three to four times more likely to experience migraine than men, in part because of the role of hormonal fluctuations.

On top of that, most of the birth control options available affect the female reproductive system, leading to more hormonal fluctuations that can trigger migraine.

Birth control types

Nonhormonal birth control:

• condoms and other barrier methods
• the copper IUD (intrauterine device)
• vasectomy
• tubal ligation (tube tie)

Hormonal birth control:

• the pill
• the patch
• the ring
• the hormonal IUD

“The birth control pill is meant to simulate or mimic your menstrual cycle while preventing ovulation and altering the cervical mucus to prevent sperm movement,” says Sherry Ross, an OB-GYN and women’s health expert at Providence Saint John’s Health Center.

Ross explains that doctors commonly prescribe two types of hormonal birth control pills:

Combination birth control pills are the most common. They contain both estrogen and progesterone.

Progesterone-only birth control pills, also known as the mini pill, are often prescribed for those who can’t take estrogen.

Birth control may reduce migraine symptoms

People may take the mini pill for reasons like maintaining milk supply for a nursing child or reducing heavy periods. Additionally, some may choose it for migraine-related reasons.

Lisa Yablon is a neurologist with Fellowship training in Headache Medicine with Neura Health. She also personally experiences migraine.

“In general, combined oral contraceptives can reduce migraine symptoms due to the sustained level of estrogen,” says Yablon. This “can reduce susceptibility to developing a migraine attack.”

A 2023 review notes that oral contraceptives may reduce migraine days, pain scores, and migraine medication use.

However, the reverse could also be true in certain cases. The same study notes that migraine “and contraception counseling is nuanced based on individualized risk.”

Birth control may increase migraine symptoms and risks

“Combined contraceptives can trigger migraine [episodes] due to major hormone fluctuations,” says Medhat Mikhael, MD, a pain management specialist and medical director at the Spine Health Center at MemorialCare Orange Coast Medical Center. “For example, women who take combined active hormones for 3 weeks and inactive pills for 1 week tend to have a major drop in estrogen.”

Like with menstrual migraine, that drop in estrogen could lead to migraine episodes.

When it comes to the mini pill, Yablon says it’s less understood. She notes that migraine may occur during episodes of uterine bleeding for women taking synthetic hormones that mimic progesterone.

Birth control and migraine with aura

When working with people who experience migraine, medical professionals will base birth control choices on whether the person experiences aura.

The CDC notes that those who experience migraine with aura shouldn’t use combined hormonal birth control.

This is due to the increased risk of:

• stroke
• blood clots
• major cardiovascular events

“Risks become much higher in patients who smoke or have a family history of stroke or cardiovascular events,” says Mikhael.

Those who experience migraine without aura can safely take combination pills without increased risk of stroke, Ross says.

Tips for taking birth control if you experience migraine

You can balance migraine risks with birth control use with the tips below.

• Stay hydrated.
• Minimize stress.
• Eat a balanced diet with a range of whole foods.
• Get regular exercise.
• Take the pill at the same time every day to maintain hormone levels.
• Take the pill continuously, i.e., avoid the pill-free week (if your doctor OKs it).
• Track migraine attacks throughout your cycle.
• Seek nonhormonal birth control methods, like condoms or the copper IUD.
• Discuss any issues with medical professionals.

Managing hydration, stress, diet, and exercise are common suggestions for migraine management, even before birth control comes into the mix. However, migraine specialists can work with you to share customized tips based on your symptoms and needs.

According to Ross, those experiencing menstrual migraine may find relief by taking the pill continuously and avoiding the pill-free week. That way, there isn’t a sharp drop in estrogen that might trigger migraine.

Those who notice worsening symptoms should contact a healthcare professional to discuss other birth control options.

According to Ross, these methods may work for those who experience migraine with or without aura:

• the IUD, with or without progesterone
• implants like Depo-Provera or Nexplanon
• tubal ligation or vasectomy
• barrier methods like condoms

Mikhael agrees that working toward a personalized care plan with a health professional is critical.

“Consult with your doctor, as he/she might switch you to a progestin-only product,” says Mikhael.

They may also refer you to a neurologist or pain specialist who can help you explore options like medication to prevent migraine.

Takeaway

Hormonal contraceptives like birth control methods can reduce or worsen migraine headaches. Experts say that hormonal fluctuations are primarily the reason for this effect.

Those with migraine with aura should avoid hormonal birth control containing estrogen, as it increases stroke risk.

Other methods, like IUDs with or without progesterone, condoms, and oral contraceptives without estrogen, are typically recommended over combination methods for those who experience migraine with aura.

Speak with a healthcare professional if you’re concerned about using birth control because of migraine or if recently starting birth control has caused migraine episodes. They can help you chart the best course and pivot if you have issues.