Migraine with Aura and Birth Control: What Are the Risks?

Migraine attacks are sometimes accompanied by a symptom known as an aura. Auras can occur before or during migraine. Some common signs of an aura include:

• visual disturbances, such as flashing or strobing lights
• tingling on one side of the face or body
• difficulty speaking

If you have migraine with aura, your menstrual cycle may be a trigger. And migraine with or without aura can be caused by the drop in estrogen that occurs right before you menstruate.

If you take birth control pills, your estrogen levels are held at consistent levels. This may decrease the risk of migraine in some people due to the lack of fluctuation in estrogen.

But the opposite can also occur — migraine can sometimes be made worse by taking birth control pills.

And migraine with or without aura may also be more likely to occur during the week that you don’t take your pill each month because estrogen levels drop during that time.

The birth control pills that trigger migraine in some people are often combination pills containing both estrogen and progesterone. Estrogen and progestin-only birth control pills don’t usually have this effect.

The timing of your migraine attack may be a clue that your birth control method is the cause — rather than a typical migraine that may have other causes.

And if you have migraine with aura, you may be especially sensitive to the estrogen in birth control pills. Your migraine attacks may also feel more intense if you’re sensitive to estrogen.

If you take hormonal birth control pills, you typically take an active pill containing estrogen and progestin for 3 weeks. During the fourth week, you take an inactive placebo pill which doesn’t contain hormones.

During that week, your estrogen levels drop as they would if you weren’t taking birth control. When estrogen dips, you may experience migraine, with or without aura.

If you take an extended-cycle pill, this drop in estrogen occurs less frequently. This can reduce how often you get migraine attacks that result from a dip in estrogen.

Other possible side effects from birth control pills that may also occur along with migraine with aura include:

• sore or swollen breasts
• light periods
• mood changes
• nausea
• break-through bleeding or spotting between periods

People who have migraine with aura are at a slightly higher risk for ischemic stroke. Taking birth control pills containing estrogen has been shown in multiple studies to increase this risk to a small extent.

If you have migraine with aura and smoke cigarettes or use nicotine products, your risk for ischemic stroke will also be much higher.

Other birth control options that may be a better choice for people who get migraine with aura include:

• progestin-only birth control pills (mini pills)
• condoms
• intrauterine device (IUD)

Migraine with aura can often be managed with medication. If your migraine attacks last longer than 1 hour or linger for an extended period of time, let your doctor know.

Seek immediate medical attention if you experience symptoms such as:

• weakness on one side of the body
• confused speech
• a reduction in alertness

If migraine with aura coincides with your menstrual cycle, talk with a doctor about your choices for birth control that won’t increase migraine severity or your risk of stroke.

Birth control can be beneficial for conditions other than preventing pregnancy, including polycystic ovarian syndrome (PCOS) and endometriosis pain. If you take birth control for health reasons, it may be important to continue even if your risk for migraine with aura is increased.

If you’re on birth control, treatments which may reduce the symptoms and severity of migraine with aura include:

• over-the-counter pain medication, such as ibuprofen
• anti-nausea drugs
• Botox injections

Some migraine with aura treatments, such as triptans, can increase stroke risk and should be avoided.

It may be hard to prevent every migraine attack, but knowing your triggers can reduce their frequency.

In addition to estrogen birth control pills, potential triggers include:

• skipping meals
• drinking alcoholic beverages, especially wine
• caffeine or caffeine withdrawal
• changing your sleep pattern or habits
• stress and anxiety
• bright light, including light from a computer screen
• sun glare
• strong smells
• food additives, including aspartame and monosodium glutamate (MSG)

Birth control pills that contain estrogen may increase your chances of developing migraine with or without aura.

Women who have migraine with aura should avoid combination birth control pills that contain estrogen because these may increase their risk of stroke.

Other forms of birth control, such as the mini pill, may be better choices if you have migraine with aura.