Migraine from Contraception Pills?

Can birth control pills trigger migraines? How is migraine related to the female cycle, and what contraceptive methods should be considered for people with migraine? Find out here.

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Last updated: February 6, 2024

To all migraine patients out there: Have you ever felt uneasy after reading the side effects on the package insert of a birth control pill?

Possible Contraindication: Migraine!

Have you ever wondered what other contraception options are available? How is migraine related to the female cycle, and what contraceptive methods should people with migraine consider? We’ll explore these questions in this article.

What Does Estrogen Have to Do with Migraine?

Some of you may have noticed that your migraine attacks hit right before, during, or after your period. This has a scientific explanation rooted in human biology. Several studies indicate that a drop in estrogen levels can trigger migraine attacks. However, it’s not the absolute hormone levels that matter but rather the change in those levels.

And there are plenty of hormonal changes throughout the menstrual cycle:

During the first half of the cycle, estrogen levels steadily rise.
Then, they slightly drop before rising again about 4–5 days before menstruation.
However, just before or during menstruation, estrogen levels drop sharply, often triggering a migraine attack.

The menstrual cycle, with its hormonal rollercoaster—up and down, up and down—creates the perfect conditions for migraines.

For those using birth control pills, migraine attacks often occur during the hormone-free pill break.

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Menstrual or Menstrually Associated Migraine?

A 2006 study by MacGregor et al. found that participants experienced significantly more migraine attacks during cycle phases with lower estrogen levels. In contrast, around ovulation, when estrogen levels are higher, migraine attacks were less frequent. This provides scientific evidence of a link between migraine occurrence and different phases of the menstrual cycle.

Another study found that 22% of women with migraine experienced over 50% of their attacks in a specific phase of their cycle.

There are two main types of migraine related to the menstrual cycle:

Pure menstrual migraine: Occurs in 5–10% of migraine patients, with attacks exclusively before or after menstruation in at least two out of three menstrual cycles.
Menstrually associated migraine: Attacks frequently occur around menstruation but may also appear at other times in the cycle.

A headache diary can help determine which type of migraine you have by tracking your menstrual cycle and headache patterns.

In addition to declining estrogen levels, other hormonal fluctuations can contribute to migraines. Hormones like estrogen and progesterone influence pain processing in the brain, making people more sensitive to stress factors before their period. Situations that might normally be tolerable can suddenly trigger a migraine attack due to these hormonal changes.

In most cases, it’s not just one factor but a combination of multiple factors that leads to a migraine attack.

Migraine from the Pill?

In the past, birth control pills were often used as migraine prevention, which made sense given that many migraine attacks are triggered by hormonal shifts before menstruation. However, newer research has led to a more nuanced perspective.

Doctors now discourage hormonal therapy with oral estrogen or hormone patches because they only delay attacks rather than prevent them altogether.

Additionally, there appears to be a link between hormonal contraceptives and migraine frequency. The large Norwegian Head-HUNT study, which surveyed 13,944 women of childbearing age, found that:

Women taking estrogen-containing birth control pills experienced 1.4 times more migraine attacks and 1.2 times more tension headaches than those using other contraceptive methods.

Interestingly, the dose of estrogen did not significantly impact migraine frequency.

Birth Control Pill = Anti-Migraine Pill? Quite the Opposite.

Increased migraine frequency was observed with both standard combination pills (containing estrogen and progestin) and low-dose “mini-pills”. However, the progestin-only mini-pill was not associated with increased headache or migraine frequency.

Caution!

If your migraine or headache attacks first appeared after starting the pill, you should discontinue it. Talk to your gynecologist about alternative contraception methods, and consider consulting a headache specialist or neurologist.

That said, some patients report that their hormonal migraines improved after starting the pill.

Menstruation and Migraine Aura – What’s the Connection?

When choosing a contraceptive method, it’s also important to distinguish between migraine with aura and migraine without aura.

Migraine Without Aura

For migraine without aura, birth control pills can sometimes help reduce or even prevent attacks. The key is to maintain stable hormone levels:

Combination pills with both estrogen and progestin can be used, but they should be low-dose.
These pills should be taken continuously for up to six months without a break, as skipping the hormone-free period helps prevent estrogen drops that can trigger attacks.

Many people experience a significant reduction in migraine attacks with continuous pill use. However, after six months, a 7-day pill break is recommended. During this break, some may still experience migraines, but often with less intensity.

Migraine With Aura

For migraine with aura, birth control pills do not offer the same benefits. In fact, the World Health Organization (WHO) advises against estrogen-containing and progestin-containing pills for patients with aura, regardless of age.

Stroke Risk

After age 35, the WHO recommends discontinuing birth control pills for migraine patients, as stroke risk increases with age. Other risk factors like smoking, diabetes, obesity, and high blood pressure can further amplify this risk.

Alternatives to the Pill – Contraceptive Methods for Migraine Patients

If your migraine attacks are unrelated to your cycle, consider non-hormonal contraceptive options like:

Copper or gold IUDs

Barrier methods (e.g., condoms, diaphragms)

Natural family planning (NFP)

If you still want to use hormonal contraception, opt for a low-dose progestin-only pill (mini-pill), which is taken continuously without a break to prevent hormonal fluctuations.

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Did you know that blood sugar fluctuations can contribute to migraines? Research suggests that keeping blood sugar levels low and stable may help prevent attacks.

With the Ebby, you can monitor how your blood sugar responds to different foods and receive personalized dietary recommendations—without strict dieting.

Conclusion

Current research does not provide a definitive answer on whether birth control pills influence migraine. The pill can have positive, negative, or neutral effects, making a thorough consultation with gynecologists and neurologists essential.

If you suspect the pill is triggering your migraines, consider stopping it temporarily to assess its impact. Many women report a significant improvement or even complete disappearance of their migraines after discontinuing the pill.

Sources

MacGregor et al. (2006)
Vetvik, MacGregor, Lundqvist und Russell (2013)
Aegidius K, Zwart JA, Hagen K, Schei B, Stovner LJ: Oral contraceptives and increased headache prevalence – The Head-HUNT Study, Neurology 2006; 66: 349-353.
Bernecker C. et al. (2011): Oxidative stress is associated with migraine and migraine-related metabolic risk in females. In: European Journal of Neurology, 18(10), S.1233-9.
Bongiovanni, D. et al. (2021): Effectiveness of Ketogenic Diet in Treatment of Patients with Refractory Chronic Migraine. In: Neurol Sci, doi:10.1007/s10072-021-05078-5.
Evcili, G. et al. (2018): Early and long period follow-up results of low glycemic index diet for migraine prophylaxis. In: Agri.30(1), S. 8-11. doi: 10.5505/agri.2017.62443.
Gruber, H.-J. et al. (2010): Hyperinsulinaemia in Migraineurs Is Associated with Nitric Oxide Stress. In: Cephalalgia30 (5), S. 593–98. https://doi.org/10.1111/j.1468-2982.2009.02012.x.
Razeghi, J. S. et al. (2019): Association of diet and headache. In: Journal of Headache and Pain, 20(1), S. 106. doi:10.1186/s10194-019-1057-1.
Siva, Z.O. et al. (2018): Determinants of Glucose Metabolism and the Role of NPY in the Progression of Insulin Resistance in Chronic Migraine. In: Cephalalgia38 (11), S. 1773–81. https://doi.org/10.1177/0333102417748928.
Yilmaz, N. et al. (2011): Impaired Oxidative Balance and Association of Blood Glucose, Insulin and HOMA-IR Index in Migraine. In: Biochem. Med., 21, S. 145–151.

About the Author

Mona Kattwinkel

Mona is a student, a young mother and, last but not least, a migraine expert. She has had migraines since she was 8 years old and is a member of a self-help group within the MigräneLiga e.V. Germany.