Menstrual migraine and contraception for migraine with aura

Sad Woman Laying On Couch

Treatment of menstrual migraines can be tricky. They are often felt as more intense, they have a long duration and they do not respond well to treatment. When they do not respond to the recommended treatments (see links below for full list of treatments) sometimes doctors suggest going on birth control to halt the drops in estrogen.

Is this an effective tool for menstrual migraines? We have heard many people say it makes them worse. Others say it helped a great deal. It seems rather confusing.

Migraine and oral contraceptive use continues to be a source of controversy. Oral contraceptive initiation may worsen or change the pre-existing pattern of migraine. In a small percentage of women, there may be improvement or no change at all. The concern of oral contraceptive use is twofold; how will it affect the migraine severity and frequency; and what is the added risk of stroke to the migraineur on the pill. Migraine may be affected by the pill in one of five ways; attacks may begin for the first time; pre-existing migraine may worsen; there may be an alteration in the pattern; migraine may improve and finally there may be no change. Some studies have suggested there is no change in headache with the oral contraceptive. Help for Headaches

It seems everyone is in fact right on this one. Many of us get worsening headaches. A small percentage get improvement and many notice no difference at all. Yet if we are at the point where other treatments have failed and these menstrual migraines are brutal what sort of options can we choose that may benefit us in this area?

Taking the Pill continuously

Dr Anne MacGregor discusses this in her books ‘Migraine and Women’ and ‘Migraine and Other Headaches’. She explains that taking the Pill continuously can stop migraines. However, because there is no controlled withdrawal bleed, unpredictable breakthrough bleeding may occur.
In Dr MacGregor’s words: ‘there is little evidence that the monthly breaks from the pill are associated with any added health benefits and that the benefits of reduced menstrual problems and increased efficacy are clear’.

The combined contraceptive pill and the risk of stroke

If you suffer from migraine with aura you should not take the combined oral contraceptive Pill. This is because the combined pill is associated with a very small increased risk of ischaemic stroke. This risk increases when the Pill is taken by women who have additional risks for stroke, such as smoking and migraine with aura. Statistics show that the risk is extremely small but never-the-less it is still a risk, which can be avoided. The risk from the Pill is due to ethinyloestradiol, and not progestogen. So progestogen-only contraceptives are a safer alternative. Some of these are more effective contraceptives than the combined Pill.

Progestogen–only pill

You may consider taking this form of contraception if you are unable to take the combined pill. Although this method suits many women, others find that erratic bleeding is a problem. This can, in turn, lead to more headaches. The Migraine Trust

I should point out in the case of migraine with aura my doctor said All estrogen based ones were Out of the question. Studies on migraines and stroke risk with migraines and aura being how they have been lately she would only put me on the Progesterone only pills.

Progestin methods are safe
The use of progestin-only methods has been promoted in headache sufferers, especially those who have a specific diagnosis of migraine, because progestins do not add to the elevated risk of stroke that accompanies migraine with aura.
Because headache is common in women of reproductive age, it is not surprising that it is listed as a common adverse event for all contraceptives, including progestin-only methods. Evidence that progestin-only methods cause or worsen headaches is slim, however. Preliminary studies indicate that mid-luteal elevations of progesterone or its metabolites could prevent migraine, compared with other times in the cycle.6 Older studies report that a daily oral progestin could prevent migraine in premenopausal women, possibly secondary to induction of anovulation. At the same time, there are clinical reports that DMPA may trigger headache as a side effect in susceptible women.
Generally, then, although progestin-only methods are likely to be safe in all patients with headache, and ovulation suppression may improve the headaches, some patients may experience worsening symptoms. OBG Management
I had worried there was, in fact, a difference between the two in their effectiveness to treat migraines. Estrogen-based vs progesterone based. From what I have found they have equal potential or not potential. The issue only raised with depo shots is the irregular bleeding which seems to cause breakthrough migraines and the bleeding can be very irregular.



Evidence of progestogen-only contraception in women with migraine

In summary, the potential advantages of using progestogen-only contraception in women with migraine are the following:
1) Continuous use
2) Absence of estrogen peak
3) No influence on threshold for cortical spreading depression (CDS)
4) No evidence of increase in cardiovascular, stroke and thrombo-embolic risk
5) No data on progestins inducing migraine

I take the depo shot and it works for me. I have no period at all and no menstrual-related migraines. I thought about all my options, considering I have an aura, and this one works for me.

More complete info on all treatment methods for menstrual migraines:

Ribbins Headache Clinic: Menstrual migraines

National Headache Foundation: Menstrual Migraine

Hormonal Contraceptive Options for Women With Headache: A Review of the Evidence



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