The Contraceptive Pill and Migraines: Debunking Common Myths
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In this article
What's the lowdown?
Migraines are more common in women than men
There are different types of migraine, and migraine attacks can also include an aura
An aura is a symptom or symptoms related to the brain or nervous system
Female hormones including oestrogen can trigger and affect migraines
Combined hormonal contraception is not considered safe to use if you suffer from migraines with aura
Progestogen-only contraception can be used if you have migraines
Understanding migraines
Headaches are frustrating and common, affecting 52% of the world population. However, migraines are less common affecting 14% of people1. Both headaches and migraines are more common in women than men(1), which is why we are writing about them at The Lowdown!
Migraines are a type of headache with distinctive features. To be diagnosed with migraine, a doctor will listen to how you describe your headaches, and what happens when you have them. They will also examine you to check for any other causes of the headache.
How do you know the difference between a headache and a migraine?
To be diagnosed with a migraine, you have to experience a number of specific symptoms. To confirm its a migraine, the following features must be present:
- A headache that lasts between 4 hours and 3 days
- At least 2 of:
- A one sided headache
- Pulsing, throbbing or banging type pain
- Moderate to severe pain
- Pain that is worsened by normal activities like walking up the stairs
- And at least 1 of:
- Feeling sick or vomiting
- Not being able to tolerate lights (usually having to sit in a dark room)
- Not being able to tolerate loud sounds or noises
Different types of migraine
There are also different types of migraine including:
- Typical migraine. This is your classic one sided migraine-type headache with the symptoms listed above.
- Hemiplegic migraine. A migraine which is accompanied by weakness on one side of the body which can be very scary to experience, especially for the first time3. (Please get urgent medical help if you think you have this!)
- Vestibular migraine, this causes symptoms of dizziness, loss of balance or vertigo.
- Ocular migraine. These migraines can cause a temporary loss of vision, usually in one eye, or flashing lights, or strange visual symptoms like zigzags, stars or black spots
- Menstrual migraines are as they sound – they happen at the time of your period!4
Migraine v migraine with aura
Another way of distinguishing migraines is whether you experience them with or without aura. Migraine with aura includes visual, sensory or speech symptoms. These symptoms spread gradually over 5 minutes and last no more than 60 minutes before completely resolving, and are often followed by a migraine headache2..
The most common type of aura is a visual aura, which can be described as blurred vision, a blind spot, zigzags or flashing coloured lights. This happens in over 90% of auras. Sensory changes happen in 36% of auras, and speech changes in 10%5
It’s important to have a diagnosis of migraine with aura, so please see a healthcare professional if you recognise these symptoms. The diagnosis can affect your contraceptive choice.
The link between oestrogen and migraines
Migraines are three times more more common in women than me6,7 especially in women of childbearing age. In fact, the most common age to develop migraines is at the age of 358 This has led researchers to investigate the impact of female sex hormones, like oestrogen, on migraine.
Research has found that a drop in oestrogen levels towards the end of the menstrual cycle, just before a period can be a trigger for migraines. Synthetic oestrogen that is used in the combined pill, patch or ring, can also affect migraines. Traditionally these contraceptives are used for 21 days followed by a 7 day break. The drop in the level of synthetic oestrogen experienced during the break from the combined pill, patch or ring can trigger migraines9.. Women who start to use combined hormonal contraception, can develop worsening headaches or migraines as a side effect10,11
Using the combined contraceptive pill, patch or ring can increase the risk of stroke, and this is higher for women who also suffer from migraines.12 The increase in risk is greatest (up to 6 times higher), if you have migraines with aura and use combined hormonal contraceptives. However, despite the increased risk, the actual number of women of reproductive age who do have a stroke (whether on the combined pill or not) is still very small. However, a stroke can impact your quality of life hugely, and for this reason, healthcare professionals will not prescribe them if you have migraines with aura.
Myths about the contraceptive pill and migraines
1. The pill always worsens migraines
This isn’t strictly true. While the combined pill may worsen migraines for some women, others find their migraines may improve, especially if they experience menstrual migraines. There is also an alternative type of pill. Progestogen-only pills are contraceptive pills that do not contain synthetic oestrogen. They deliver the same dose of progestogen each day and some of the pill brands also stop you releasing an egg (ovulating) each month. If ovulation doesn’t happen, there is no drop in oestrogen levels throughout the cycle. Data has shown that the progestogen-only pills can be taken if you have migraine13 and may improve migraine, rather than worsen them14
2. Any pill can be used for migraines with aura
Incorrect! If you have migraine with aura, it is not considered safe to take the combined pill due to the increased risk of stroke. However, the progestogen-only pills can be taken if you have migraine with aura15
3. Stopping the pill will cure migraines
Stopping the pill will not necessarily improve migraines. This depends on the type of pill you are using. Stopping the combined pill may help migraines if they have worsened in intensity or frequency since you started taking it. However, stopping the progestogen-only pill may not have any impact on your migraines. There are other triggers for migraines, and completing a headache diary can help you to identify them.
Choosing the right pill for migraines
If you suffer from migraines, you should speak to a healthcare professional about your options.
If you have migraines with aura, you should not be prescribed the combined pill as it is not considered safe due to the increased stroke risk. However, you could choose a progestogen-only pill.
If you have migraines without aura, you may be able to try the combined pill, but if your migraines start to worsen, then this should be stopped. The progestogen-only pill is an option if you do not want the combined pill, or you need to switch to an alternative.
Of course, there isn’t only the pill! There are other contraceptive options which are suitable for women who suffer from migraines. You can discover other options using our contraception recommender quiz.
If you suffer from migraines, please speak to a healthcare professional about your options. It is a discussion they are trained to have – and have regularly given that migraines are so common!
For more support, information or help with your migraines, The Migraine Trust is a fantastic charity with plenty of resources.
Dr Fran Yarlett
Medical Director, The Lowdown
Dr Fran is Medical Director at The Lowdown and works as a GP in Sheffield with a special interest in complex medical patients and women’s health.
Our medical review process
This article has been medically reviewed for factual and up to date information by a Lowdown doctor.
