The Hot Button Topic of Migraines & Contraceptives

By Jorie & Kirstie

It’s one of the most controversial topics out there right now: birth control. No doubt you’ve heard that political button being pressed numerous times on Facebook, Twitter, the nightly news, and probably around the office too.

However, right here in our very own backyard of migraine life, contraceptives are alive and well. For many of us, they’ve been THE answer to our migraines, remedying the hormonal triggers and balancing what our bodies have repeatedly refused to stop over- or under-producing.

Hormonal Migraines & How Contraceptives Can Help (or Even Hurt)

Many migraines are hormonal in nature, meaning that the natural fluctuation of hormones in a woman’s body during her cycle, whether it be ovulation or menstruation, trigger attacks. Hormonal migraines are the most common type of migraine experienced by females; in fact, according to the Migraine Trust, only about 10% of women with migraine have any other type of migraine at all.

The Migraine Trust also reports that around 50% of women with migraine say their menstrual cycle directly affects their migraines. Hormones tend to be the most commonly reported trigger for migraine attacks in women across all ages, but especially in teenagers.

A study done by the Department of Obstetrics and Gynecology at Brigham and Women’s Hospital indicated that migraine affects as many as 37% of reproductive-age women in the US. Hormonal contraception is the most frequently used form of birth control during reproductive years, with up to 43% of US women selecting a hormonal method.

The hormones estrogen and progesterone play key roles in regulating the menstrual cycle and may also affect headache-related chemicals in the brain, according to the Mayo Clinic. Having steady estrogen levels may improve headaches, while experiencing estrogen levels that dip or change can make headaches worse.

Dr. Ann H. Calhoun, GYN, explains how hormonal therapy such as birth control can greatly help women with hormonal migraines:

The goal of hormonal therapy is to eliminate or sufficiently minimize the premenstrual decline in estrogen that is believed to precipitate menstrual migraine. An observational study of 229 women found that hormonal strategies prevented MM in 73% of cases (81% when taken as directed).”

However, taking hormonal therapy has the potential to hurt those of us with other types of migraines, especially those who have migraine with aura. Taking birth control increases the risk for transient ischemic attacks (mini stroke) in patients who also have migraine with aura. Auras are not associated with hormonal or menstrual migraines.  

Further investigation in the same study as above suggested that migraine, particularly migraine with aura, is associated with an increased risk of transient ischemic attack, and that this risk may be further elevated in the setting of combined estrogen-progesterone contraceptive use. There are no studies that directly compare the risk of stroke in migraineurs with and without aura using estrogen-containing contraception.

Guidelines recommend progestogen-only contraception as a safer alternative option because it does not seem to be associated with an increased risk of venous thromboembolism or ischemic stroke. Additional risk factors for TIA or stroke include smoking, hypertension, diabetes, and women aged over 35 years.

Our Experiences (Others May Vary)

– Jorie

From personal experience, I can tell you that my hormonal migraines are about ten times worse than a migraine triggered by other means, but I have both hormonal migraines and other types of migraines. Hormonally triggered migraines are painful from head to toe, they respond to almost no treatment, and they can last for days.

Birth control was still a rather taboo topic even when I went on it in my late teens. And because of that, I kept thinking I was wrong for going this route: no way, I’m not doing this, how can this help my migraines?

I realized later that was wrong for thinking that way, but it’s simply how I was raised. The talk of sex was, while encouraged at certain points, still a little unthinkable as a teenager. I’m much more open about my use of birth control today, especially now that I’ve been educated on the many ways that birth control can benefit women. It is NOT just a “birth control,” or a prevention mechanism, as discussed above. I don’t know how many times I’ve had to reiterate that fact to people.

I’d tried 5 different types of contraceptives before landing on the one I currently use and love: the NuvaRing. All the other types of birth control I took were pills in that little blister pack, whether in its own fancy container or complete with little stickers — you know the ones. For each one of these BCs you have to take the pill at the same time each day, no skipping a day (let alone a few hours), and once the placebo week arrives you’re taking sugar pills to keep the habit up. And then it starts all over again.

But unfortunately, this method didn’t work well for me. At all.

The reason this didn’t work for me was either due to the incorrect combination of hormones, in combination with my having to endure a placebo week. The massive fluctuation in my hormones in that timeframe caused awful, awful migraines and other hideous symptoms. My body didn’t hold back — it was a monster to me.

Then, enter the NuvaRing. And no, I’m not getting paid to sponsor them or promote them or whatever it sounds like; I promise. It’s just what works for me nowadays. The NuvaRing is a flexible round ring that is inserted monthly by vaginal route. Let me explain my methodology for taking NuvaRing, because it is a little unique. However please don’t do this yourself without discussing with your doctor or GYN first.

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I take the NuvaRing every 4 weeks instead of every 3 weeks to ensure that my hormones are always at a consistent level. I never have any fluctuation, so in turn, I don’t go through the ovulation cycle either. I don’t have a period or any symptoms of menstruation. This concept is called menstrual suppression.

Menstrual suppression is a bit controversial in the gynecology community because some doctors argue that it can be irreversible after practicing it for long timeframes, causing infertility. This is strictly something that I have done closely under my GYN’s monitoring and with ethical agreements.

It should not be done on your own, due to the higher risk of stroke and blood clotting, and if you are of child-bearing age, it can also be a risk to your fertility as I mentioned above. I had to a choice to make: keep my chronic hormonal migraines, or possibly give up my chances of children. I chose the former, which is a very personal decision, but a decision I’m happy I made.

Because of my stabilized hormones, they are no longer a trigger for my migraines. It’s been an excellent fix for that problem, although I do still have many other migraine triggers that I can’t control. I am grateful, though, that I CAN control this one to a very successful degree.

– Kirstie –

Like Jorie’s experience, I myself didn’t have much luck with the monthly birth control pill packs, or the “seasonal” birth control methods, and had no luck whatsoever with the Depo-Provera Shot. I have PCOS as well as hemiplegic migraines, which are also unfortunately accompanied by many other illnesses which complicates my options for taking contraceptives.

For me, I’ve discovered that the Implanon is my saving grace. This small matchstick-like implant is inserted into your arm through a painless out-patient procedure by your GYN. The Implanon prevents pregnancy for up to three years. This is an estrogen-free birth control, which can be more beneficial for some who battle migraines.

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As Jorie suggested, always consult your gynecologist, neurologist, or other doctor and discuss which types of birth control you have tried and failed. They will be able to help you come to a conclusion as to which one is right for you through trial and error, although this can take some time. It’s important to be patient.

In the end, knowing the facts about birth control and their side effects can help you get some peace of mind and even some relief from your illnesses.


Sources:
https://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/in-depth/headaches/art-20046729
https://www.migrainetrust.org/about-migraine/trigger-factors/menstruation/
https://www.migrainetrust.org/about-migraine/types-of-migraine/menstrual-migraine/
http://www.mdedge.com/obgmanagement/article/63848/gynecologists-role-managing-menstrual-migraine/page/0/2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735427/#__ffn_sectitle
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938905/
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