Migraine contraception is a condition that occurs in women who are on birth control pills. Historically, women with migraine were not given the pill
as many obstetricians were afraid of increasing a women's risk of stroke.
Both migraine and stroke are associated with altered cerebral blood flow, focal neurological deficits, and headache. In 1975, the Collaborative Group for the Study of Stroke in Young Women suggested that migraine may be a risk factor for stroke.(1) In that case-control study, the risk for stroke was doubled in women with migraine compared to community controls. In a subsequent case-control study, Tzourio et al found a 400% increase in the risk of stroke in women with migraine under age 45. (2) Smoking and overuse of ergotamine may further increase the risk.(3)
The annual rate of cerebral migrainous infarction has been estimated at 3.36 cases per 100,000. Stroke appears to be most strongly associated with migraine with aura. (4) The causal relationship between migraine and stroke is complex and not fully understood. Migraine may coexist with stroke, stroke may occur with the clinical features of migraine, or stroke may be induced by migraine. In the last case, a prolonged migraine aura may cause a condition called 'true migrainous infarction.(5,6) The deficits caused by migraine-related stroke may improve or resolve completely with treatment; in other cases the deficits are permanent.
This is unfortunate as clearly at that time, migraine was not as well understood as it is now. Many women
were denied a medication that could have prevented pregnancy. Although taking birth control pills can increase risk of stroke as does migraine, the most common cause of stroke in the United States is still....obesity.
At the present time, many hormonal headaches can be tied to the use of birth control pills. Sometimes when women first start the pill, their headaches will worsen and happen all throughout the month. If that is the case, the pill should be stopped immediately.
Another type of headache that occurs on the pill is one that is strictly menstrually related. Although you do not have a true period while on the pill (because there is no ovulation) there is a bleeding time at the end of three weeks of the pill. Some women will continue to get a migraine during that week, but many times it is less in intensity.
Treatment of Migraine Contraception Headache
Many of my patients have worked with their OB/GYN's and been placed on a progesterone only pill (Mircette) or perhaps a 90 day cycling pill such as Seasonale, which decreases the headache occurring only during the bleeding week to only four per year. Rarely, a few patients are on the pill every single day to help prevent severe migraines.
At the present time I do not recommmend Depo-Provera which is the progesterone shot injected every 90 days. Why? Well how do you know whether or not you might be one of the few who gets progesterone related headaches? This actually does happen. If taking oral progesterone, it is easy to stop, but if on the shot, there is nothing to do but wait it out until the hormone is out of your system. Not the best migraine contraception combination.
1. Collaborative Group for the Study of Stroke in Young Women. Oral contraceptives and stroke in young women. JAMA. 1975;231:718-722.
2. Tzourio C, Tehindrazanarivelo A, Iglesias S, et al. Case-control study of migraine and risk of ischemic stroke in young women. Br Med J. 1995;310:830-833.
3. American Council for Headache Education. Migraine: A Complete Guide. New York: Dell Publishing, 1994.
4. Rothrock J, North J, Madden K, et al. Migraine and migrainous stroke: risk factors and prognosis. Neurology. 1993;43:2473-2476.
5. Welch KMA. Relationship of stroke and migraine. Neurology. 1994;44(Suppl 7):33-36.
6. Silberstein SD, Lipton RB, Goadsby PJ. Headache in Clinical Practice. Oxford: Isis Medical Media Ltd, 1998.