History of Migraine Headaches

A history of migraine headaches is not necessarily a contra-indication to taking birth control pills.

Some women with simple migraine headaches find they have fewer headaches while taking BCPs. This is particularly true for those women whose headaches primarily occur with ovulation or around the time of the menstrual flow. Other women with migraine headaches find the BCPs have no noticeable effect on their headache frequency or severity. These women may safely take BCPs.

The reason migraines often improve among women taking BCPs is because the pill suppresses ovarian function, substituting the normally wide monthly hormonal swings (which are capable of provoking migraines) for the BCP moderated lower levels and more constant and levels of female hormones. This increased hormonal stability reduces or eliminates one of the provoking agents for migraines.

But not all women with migraines will improve. Some find their migraines worsening. Typically, these women are using a BCP that is not effective in suppressing their ovarian function. Consequently, they do not experience lower, more stable blood hormone levels, but instead continue to experience the wide natural monthly swings in hormone levels. But even those natural swings are worse because of the additional hormone from the BCPs. These women don't become pregnant, because the pill does other things to prevent pregnancy besides suppressing ovarian function. But their migraines may worsen because their hormones are even less stable than when they weren't taking the pill. These women may benefit by switching to a different pill with a stronger progestin (and longer half life) to increase the likelihood of ovarian suppression. But if their symptoms continue, they will likely need to stop the pill altogether.

Women who experience migraine headaches preceded by an aura have been found to have an increased risk of stroke, particularly in the presence of other risk factors such as smoking. Some physicians recommend that because of this risk, these women should never use combination oral contraceptive pills, which may further increase the risk of stroke. Others disagree, believing that this should be an individualized risk/benefit assesment for each patient. Most are in agreement that progestin only pills may be safely used among these women.