The following conclusions where taken from a 21 page article on Medscape about the association between oral contraceptives (birth control pills) and migraine headaches. The entire article is very good and contains a host of important information and study summaries for many of the different hormonal contraceptives that are available.
In my clients that suffer from migraine headaches, one of the first approaches that I suggest, whenever possible, is a 3 month withdrawal from all hormonal forms of birth control. This has been very effective, in many cases, at treating the migraine headaches.
One of the most significant cases that I have ever seen was a women with continuos migraine headaches, that only stopped after her contraceptives where discontinued.
In summary the conclusions are not entirely inline with some of the pertinent information presented by the writer, however we can agree on one thing, migraine suffers that present with an aura (typically a sensation of light or stars that occur with the migraine headache) should be strongly advised to use non-hormonal contraceptive techniques whenever possible to reduce their risk of heart disease and stroke!
For other causes of migraine headaches, along with treatment techniques, please consider a consultation.
Contraception and Headache
Posted on Medscape by E. Anne MacGregor, MD
Conclusions
For the majority of women with headache and migraine, the choice of contraception is unrestricted, and the method is likely to have little impact on headache. Health care professionals prescribing topiramate should be aware of the potential for reduced contraceptive efficacy. Accurate diagnosis and recognition of the effects of hormonal contraceptive on migraine can enable the health care provider to manipulate the contraceptive regimen to manage the migraine. Methods that effectively suppress ovarian activity, particularly continuous combined hormonal regimens, eliminate the risk of estrogen “withdrawal” migraine.
Use of low-dose COCs is associated with a twofold increased risk of ischemic stroke compared with nonusers. As yet, there are insufficient data to assess the risk of ischemic stroke associated with the combined hormonal patch and vaginal ring.
Migraine with aura is also associated with a twofold increased risk of ischemic stroke compared with women with migraine without aura or no migraine. There is evidence to suggest that the combination of these and other risk factors, including use of combined hormonal contraceptives, is multiplicative rather than additive. Given the availability of more effective methods of contraception that are not associated with increased risk of ischemic stroke, it is difficult to justify exposing women with migraine with aura to unnecessary and avoidable risks solely for contraceptive purposes. However, when a contraceptive method is used for a medical indication such as endometriosis or polycystic ovary syndrome, the risk/benefit ratio differs and may well shift toward the benefits of combined hormonal contraceptive use outweighing risks. This should be considered on a case-by-case basis.
In contrast, migraine without aura appears to have minimal, if any, effect on ischemic stroke risk so combined hormonal contraceptives are a contraceptive option for women with migraine without aura at any age. They may also be considered for the management of menstrual migraine, particularly if the hormone-free interval is shortened or eliminated. Modifiable risks such as smoking can be controlled by advising women to stop smoking. Other risk factors, such as hypertension and hyperlipidemia, should be treated if they do not, in themselves, contraindicate combined hormonal contraceptive use. Nonethinylestradiol methods should be considered in women who are at increased risk of ischemic stroke, particularly those who have multiple risk factors.
These recommendations are based on limited data, and the paucity of research on the effects of contraceptive hormones on headache and migraine needs to be addressed, particularly with respect to progestin-only methods. There is considerable potential for contraceptive hormones to benefit women with migraine but well-conducted clinical trial data are lacking. Contraception is a rapidly developing field, and the development of newer and even safer hormonal methods will provide greater choice for women, with and without migraine.