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Living with Migraine

Migraine with Aura and Birth Control

  • By EriCha

    I have had migraine with aura since I was a toddler. I have been on birth control pills (the kind with estrogen) since I was 15. I am 28 now.

    I had never had a doctor say anything about a connection or contraindication between migraine and estrogen. Last year, I saw a neurologist for the first time and she mentioned that the estrogen could slightly raise my stroke risk and it was something to consider but overall my absolute stroke risk was not very high so she saw no reason for me to stop taking the estrogen unless I wanted to. Which I didn’t.

    Then this February I had a physical with a substitute for my primary care doc. I needed a refill of my birth control and she refused to give it to me because I have migraine with aura. She made a big deal out of it and said it was a huge contraindication. So I left her office with no prescription for pills and instead I started the depo birth control shot, which does not contain estrogen.

    The depo has been horrible. It has caused me to lactate for the last two months with no signs of stopping. This is affecting the physical aspect of my marriage. I have also had a major increase in acne, more acne than I have ever had in my whole life. These two side effects have combined to slaughter my self-esteem.

    I contacted my regular primary care doc just last week and explained that I can’t continue on the depo shot and I want to go back on the pills. There are other options… The IUD doesn’t contain estrogen but it has its own list of side effects and for women who have never given birth like myself, it can be very painful to have it put in and can cause cramping for several months. That doesn’t sound like a good option for me. And of course there are steps my husband could take… but before I was on birth control I had extremely heavy, painful, completely disabling periods. I missed a lot of school because of them and I am not willing to miss a lot of work because of them now. So I need to be on some sort of hormonal birth control.

    My PCP contacted me back today and she is refusing to give me the pills. I started sobbing. I feel like I have no control over my own body: my reproductive system or my migraines. I feel like these two aspects of my body are conspiring together to torture me and take away any choice or control I have in my own healthcare.

    I have never heard before that estrogen and auras are such a big deal together. I’ve searched this website and don’t see much info about it. Have any of you encountered this? is this a recent discovery? My doctor will not give me an explanation for her sudden change (she herself had filled my prescription for pills many times over the years and now suddenly refuses). Perhaps there have been new recent studies done that show a higher stroke risk than doctors previously thought? Is my doctor just wrong?

    I feel very stressed about this whole thing (and that stress is probably causing some of my migraines!). If anyone in this community has experienced this or has any info, I would really appreciate hearing from you.

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  • By AmyBabee

    I don’t know why they did that but I am taking estrogen currently and it just about saved my life. My migraine pain level reduced drastically that all I had to do was take 1 tab. of tylenol around the time of my period and I’m okay for the day. My GYN took me off the combination pill also due to fear of stroke and put me on single hormone pill (estrogen) since I am a non-smoker. I am thinking these pills are free at family planning clinics? I take them daily without break, that way, no chance of my period showing up at all.
    If you have a GYN, please have a rational conversation with them and find out why they stopped giving it to you; you might actually be surprised. Also read this article from one of the members here:
    https://migraine.com/stories/bio-identical-progesterone-and-estrogen/comments/#comment-39241 I hope you feel better. I am rooting for you.

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  • By Gemma Joyce Moderator

    Hi 21os7t5,

    I’m very sorry to hear of the side effects you are experiencing with the change in contraception and impact on your quality of life.

    The American College of Obstetricians and Gynecologists (ACOG) and World Health Organization (WHO) recommend that women with migraine with aura avoid the use of combined hormonal contraception. This is due to the increased risk of stroke with both migraine with aura and estrogen-containing contraceptives.

    Do you experience migraine with aura currently, or only in the past?

    I am sharing the statistics below from a 1997 review study looking at migraine with aura and combined hormonal contraceptives as risk factors for stroke in women under age 35 (from The Migraine Trust website):
    “- those who do not have migraine and do not take the pill (i.e. the background risk): 1.3 per 100,000 women per year are at risk of stroke
    – those who have migraine without aura but don’t take the pill: 4 per 100,000 women per year at risk of stroke
    – those who have migraine with aura but don’t take the pill: 8 per 100,000 women per year are at risk of stroke
    – those who don’t have migraine and take the pill: 5 per 100,000 women per year at risk of stroke
    – those who have migraine with aura and take the pill: 28 per 100,000 women per year at risk of stroke
    – those who have migraine without aura and take the pill: 14 per 100,000 women per year are a risk of stroke
    To put this into context, other studies have suggested that 8 per 100,000 women per year might die in a road accident and 167 per 100,000 women per year might die from a smoking related problem.”
    http://www.migrainetrust.org/factsheet-stroke-and-migraine-10891

    The American Headache Society has a good factsheet here:
    http://www.americanheadachesociety.org/assets/1/7/Susan_Hutchinson_-_Use_of_Oral_Contraceptives_in_Women_with_Migraine.pdf

    More in-depth information is available in the following review article:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938905/

    Some doctors may not view migraine with aura as an absolute contraindication to the use of combined hormonal contraception. You can read Dr. Hutchinson’s take here:
    https://migraine.com/blog/estrogen-friend-or-foe-for-women-with-migraine/

    Do you have a headache specialist and or/gynecologist? It may be helpful to discuss the management of your migraines and contraception with a specialist, as they will be best equipped to weigh up the potential benefits and risks of any treatment. Each person is unique and it is worth having an experienced clinician consider all the factors to see what may be suitable in your particular case.

    Have you mentioned to your doctor about the symptoms you are experiencing? Whilst lactation (“galactorrhea”) can occur as a side effect of Depo-Provera, it is always best to be seen by a doctor to check there are no underlying issues. More information on galactorrhea can be found here:
    http://www.mayoclinic.org/diseases-conditions/galactorrhea/basics/definition/con-20025628

    I have shared a lot of links as I got the feeling you were looking for detailed information to be able to discuss with your doctors.

    Please let us know how you get on.

    Gemma

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  • By Kat

    When my gynecologist found out I had migraines, he sent me to a neurologist and took my off birth control until after my appointment with the neurologist. At the time, I was being unsuccessfully being treated for my migraines by a family physician so being sent to a neurologist was a relief to me.

    During my first appointment with the neurologist, I brought up needing birth control to help control my extremely painful menstrual cramps. I was told that I could go on a low dose pill so I could control the cramps and reduce my risk of stroke since I also had aura migraines.

    After the appointment, I called my gynecologist office and relayed with my neurologist told me and I was put on a low dose.

    See if your PCP will refer you to a gynecologist. It’s worth a try!

    Good luck! 🙂

    -Kat

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  • By jbrandsen33

    I just recently ran into this problem as well! I have been on the pill since I was 17. I am 21 now, and I am just now hearing about this increased risk of stroke for those with migraine with aura. It was actually my pharmacist who mentioned this to me. I was picking up a new migraine medication, and the subject of the type of birth control I am on came up. He said he was shocked my doctor even prescribed me this type of birth control and the migraine medication when she knew my migraine history. I mentioned this to my doctor, and she said she was under the impression that I didn’t have migraine with aura. At first she just recommended trying a new form of birth control to combat this risk. After I didn’t respond to her email she went ahead and sent a prescription over for the mini pill, because she strongly advised against continuing the pill I was on at the time. I haven’t started the mini pill yet, but I have been told that it is only 95% and you MUST take it at the same time every day in order for it to work. Miss a pill by 3 hours and you’re screwed. I have grown very accustomed to the birth control I am on now and I really don’t want to have to go through the possibility of experiencing side effects from something new. But since I have no interest in getting an IUD, getting the shot, or getting the weird bar implanted in my arm, it seems like this is my only choice
    I too am very confused and annoyed about this apparently new discovery

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    • By MRSK0521

      @jbradsen33 I’ve been in the same predicament for about 2 years. I was seeing an OB & a neurologist for my migraines and was on Levora. It worked well for me and literally cut my periods down to 3 days and then it was almost non existent. Then I lost my insurance and started seeing an income based office. The NP there freaked out when I told her I wanted her to refill my script for combo birth control. She refused to write it and wanted me to see THEIR neurologist when I wanted her to just reach out to my old neurologist. So I went and seen their neurologist and we talked. He put me on meds for the migraines and told me I was fine to take the birth control since I’ve been taking it with out any issues with the migraines. Well I had a phone visit with the NP she said she would put the birth control in and then when I went to pick up it was not the birth control we had discussed it was the mini pill. Well I picked it up and called her and she stated that she didnt feel comfortable prescribing me the combo pill and she wanted me to try the mini pill. I was upset but I decided to give it a try. It was the worst decision I have ever made in my life. I took the pill and from the first day that I took it my period started and 3 months later I was still on my period. My flow was super heavy, I was super emotional, irritable, and just felt awful. Well I regained insurance and went back to another doctor at my old facility. I talked to her told her what the NP thought and she told me that I should try the depo-provera since it is progestin only and it would stop the bleeding all together. I was willing to try it because I had been on depo about a year before the combo pill and it was great for me. So I received the injection and it did stop the bleeding about an hour later and it didnt come back my next cycle. So I’ve been on depo for about a year and a half now and this go around the depo is definitely not what I want to be on. I love the fact that I don’t bleed, not even break through bleeding but the other side affects that have reared up are too much. I’ve gained about 20 pounds since I’ve been on depo-provera this last year. In the last few months I’m super moody, emotional, depressed at times, and sometimes I get these suicidal thoughts which I have read are side affects of depo. I talked to my NP at my last visit as I’m with a new facility after losing my insurance again and she thinks I should be off the depo and on the IUD because I’m not planning to have kids for about 5-8 years. She also says the weight gain is from the birth control. Due to finally gaining insurance again, I will be going back to my old facility. I want to talk with the doctor about putting me back on the combo pill the one I was taking before (Levora). I go back to the doctor on July 3, so I’m hoping to be able to change back over. I really dislike the depo and I refuse to get and IUD or the Nexplanon are implant because I am not putting a foreign object inside my body (though I use BC) I refuse to put those devices inside of me after hearing and read so many negative things about the.

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  • By cherrybelle

    I recently ran into this same issue when switching PCPs. She alerted me that I should not be on the pill with aura migraines. I am not interested in an IUD. Long story short, I went to my neurologist and his take was that he feels the risk for stroke with aura migraines and the pill should not be looked at in a vacuum – that other risk factors need to be taken into consideration. Ex: do you smoke? do you have high blood pressure? If you do not have other risk factors, the risk of having a stroke due to aura migraine/pill connection is small.

    But I certainly understand a doctor’s perspective of, why risk it at all if you can avoid it. But for me and I’m sure a lot of you, birth control has many benefits besides contraception. I opted to stop taking birth control entirely (because, why risk it if I can avoid it) to see if I could do it and it has been TERRIBLE! Headaches worse, terrible bleeding, moodswings, etc. I plan to go back on the pill.

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