Migraine is one of the most frequent forms of a primary headache, which is 2-3 times more common in women than in men. This fact confirms the role of sex hormones and their fluctuations in the development of the disease. The peak of morbidity falls on the reproductive age (25-40 years), which is associated with certain difficulties. One such method is contraception because it is a well-known fact that taking birth control pills is often associated with a side effect such as headache or migraine.
Nevertheless, the use of hormonal contraceptives is indicated not only to prevent unwanted pregnancies, often preparations containing estrogen and gestagen are prescribed for therapeutic purposes, for example, for the treatment of endometriosis, menstrual irregularities, treatment of polycystic ovaries and other gynecological diseases. How to be in such cases? Should a woman with migraine continue to take birth control pills or should they refuse such treatment in favor of other methods?
Relation of Migraine to Sex Hormones
The role of female sex hormones in the development of migraine confirms the fact that there is a direct relationship between the fluctuations of hormones in a woman’s blood and the development of a headache. There are 2 types of migraine associated with the female cycle:
- true menstrual migraine is a headache attack that meets the criteria for migraine and occurs exclusively in the period from 2 days before the onset of menstruation to 3 days of menstrual bleeding. This migraine should occur in 2 of 3 cycles and does not develop in other periods.
- migraine, associated with menstruation, is a headache that meets the criteria for this disorder and can occur both before menstruation itself and during other periods of the female cycle.
The exact cause of migraine development is not established today, but it is known that there are 3 components in the formation of a migraine attack:
- vascular;
- nervous;
- endocrine.
An endocrine cause is the predominant one in the development of menstrual migraines. A number of scientific papers have shown that increasing the amount of estrogen reduces the frequency of migraine attacks without an aura, but worsens the prognosis for migraine with aura. Thus, estrogen-containing birth control pills cannot be used for migraine with aura, but it is possible for an ordinary type of disease. Some women even experience improvement with oral contraceptives.
In the late luteal and early follicular phase of the cycle (perimenstrual period), the maximum decrease in the number of estrogens occurs, which leads to the development of a headache.
The role of estrogen is confirmed by the fact that migraine attacks occur during pregnancy very often when the woman has a constant and stable concentration of estrogen hormones. If migraine worsens during pregnancy or occurs in the first trimester.
Thus, if a woman with migraine wants to take oral birth control pills it is important to consult a gynecologist. Depending on this and on the presence of other risk factors for stroke, the type and composition of the contraceptive pills will be selected, and perhaps combined birth control will be categorically contraindicated.
How do Oral Contraceptives Affect this Disorder?
Recent clinical studies prove that taking birth control pills can cause the onset of migraine, and in the case of a pre-existing disorder, it can aggravate its course, increase its attacks, and develop insensitivity to medications for its treatment.
But such birth control pills do not always provide such an effect. It happens due to the fact that this disorder is not one disease, but a whole heterogeneous group of pathologies. For example, some women, on the contrary, feel a relief of migraine attacks or their complete cessation while taking combined oral contraceptives and use these drugs as a prophylactic. Usually, this phenomenon can be observed with migraine without aura.
Migraine with aura is another story. According to the latest statistics, this type of headache increases the risk of developing ischemic stroke, therefore, differential diagnosis of a headache in women who plan to take birth control pills is very important, since oral contraceptives further increase the possibility of developing a stroke in women with migraine, which is accompanied by aura. The risk of stroke in women with migraine who take contraceptive pills is increased 2-4 times compared to those who do not use them and 8-16 times if compared with women without migraine and without COCs application.
Basically, these data concern preparations that contain estrogen, tablets that have progestins in their composition are safer. The World Health Organization has identified the possibility of taking them in women with migraine.
What Method of Contraception to Choose?
According to modern gynecological recommendations, the use of estrogen-containing oral contraceptives for women with migraine, especially with aura, is contraindicated. Preference should be given to barrier methods of contraception, the use of an intrauterine device or oral contraceptives based on progestins.
With regard to combined birth control, the algorithm for the possibility of their use in migraines is as follows:
COCs are absolutely contraindicated in cases where the health risk significantly exceeds the benefit of their use. This situation is observed when it is a type with aura.
COCs are relatively contraindicated in cases where the risk when taking tablets exceeds their benefit. This situation occurs with migraine without an aura in the presence of an additional risk factor for stroke. In such cases, a woman should be informed of all the risks and possible consequences, only after that she can make a choice.
COCs are not contraindicated when the benefits of their use exceed the possible risk of stroke. This situation is observed with migraine without aura when there is no additional risk factor for stroke from the above.
Birth Control Pill Best for Migraines
Birth control pills based on gestagens can be used in patients with migraine (in some cases, even with aura). They do not contain estrogen hormones in their composition, which are the link in the pathogenesis of menstrual type of a headache. Such drugs can be found under the name “mini-pills”.
They are indicated to prevent unwanted pregnancies in women after 40 years of age, as well as in nursing mothers. These contraceptive pills can also be used by patients with migraine, which are contraindicated combined medications with estrogen content. The contraceptive effect of mini-pills is slightly lower than that of COCs, but the drugs of the last generation are practically not inferior to them in this aspect.