How Continuous Birth Control Pills Prevent Migraines

Stopping Migraines During Your Period with Birth Control

woman taking birth control pill
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Menstruation is a common migraine trigger for women. The good news is that there are a number of options to treat your menstrual migraines, including continuous birth control pills.

Basics of a Menstrual Migraine

Menstrual migraines strike anywhere from two days before to three days after the start of menstrual flow, and unfortunately, they tend to be more severe and less responsive to medications than migraine attacks that occur during other parts of the month.

While scientists are not completely sure why these attacks occur, there is strong evidence that estrogen, a hormone that helps regulate the menstrual cycle, is involved.

One theory is that the drop in estrogen that occurs right before menstruation excites the brain regions that are involved in a migraine, triggering an attack. This is supported by the fact that women with migraines tend to get more migraines in perimenopause—a period of time prior to menopause when a woman's estrogen levels fluctuate.

Likewise, during the second and third trimester of pregnancy, many women obtain migraine relief, which is again attributed to the naturally high levels of estrogen in a woman's body. 

While some women experience pure menstrual migraines, which are attacks that only occur during menstruation, most women suffer from menstrual-associated migraines, which are migraine attacks that occur during menstruation, as well as other times of the month.

How Menstrual Migraines May Be Prevented

Menstrual migraines can be prevented with long-acting triptans, like Frova (frovatriptan) or Amerge (naratriptan). Usually, they are taken for five to six days in the perimenstrual period, which begins two days prior to menstrual flow. Another option some doctors recommend is magnesium, although it needs to be taken longer, for about two weeks prior to a woman's period starting.

For some women, taking a continuous combination birth control pill, which consists of both estrogen and progestin, can reduce the frequency of menstrual migraines. The theory behind using continuous birth control pills is that the pills prevent any significant estrogen drop from occurring in your cycle.

Am I a Candidate for Continuous Birth Control Pills for My Menstrual Migraines?

Certain factors of your medical history will need to be considered before your doctor will prescribe birth control pills. For instance, according to the American College of Obstetricians and Gynecologists, a woman with migraines may be prescribed combination estrogen-progesterone birth control only if she has migraines without aura.

This is because having migraine with aura increases your risk of stroke, and this risk may be further increased by taking birth control pills, especially ones that have a higher estrogen content. Other factors that contradict your ability to take combination birth control include smoking, age 35 or over, or certain health conditions, like high blood pressure or a history of a blood clot.

If your doctor does prescribe birth control pills for your migraines, you may take the pills continuously to keep your estrogen levels constant.

This means skipping the placebo pills if you have a 28-day pill pack, or taking a pill everyday (no skipping needed) if you have 21-day pill packs.  

Though some continuous birth control methods can help prevent menstrual migraines, it should be noted that many people suffer attacks immediately after the pills are stopped, or during pill-free points of the month.

A Word From Verywell

It's important to keep in mind that birth control pills may not be the best method to treat your migraines.

Please consult with your doctor to determine what the best treatment strategy is for you. Your doctor may ask you to keep a diary of your attacks for several months, noting each time you experience a migraine and the dates of your menstrual flow.

This way your doctor can decide whether few, some, or most of your migraines are triggered by menstruation

Sources:

De Leo V. Combined oral contraceptives in women with menstrual migraine without aura. Fertil Steril. 2011 Oct;96(4):917-20.

Edlow AG & Batz D. Hormonal contraceptive options for women with headaches: a review of the evidence. Reviews of Obstetrics and Gynecology 2010 Spring;3(2):55-65.

MacGregor EA. Prevention and treatment of menstrual migraine. Drugs. 2010 Oct 1;70(14):1799-818.

Martin VT. (n.d.). American Headache Society. Menstrual Migraine: New Approaches to Diagnosis and Treatment.

Nappi RE, Merki-Feld GS, Terreno E, Pellegrinelli A, & Viana M. Hormonal contraception in women with migraine: is progesterone-only contraception a better choice? J Headache Pain. 2013;14(1):6.

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