Key takeaways

Migraines with aura are often linked to high estrogen levels, and identifying an aura is crucial for understanding and managing these migraines.
Estrogen-containing birth control pills pose a significant stroke risk for individuals with a history of migraine with aura, due to the hormone’s effect on blood clotting and headache exacerbation.
It’s essential to share a complete medical and family history with healthcare providers so they have all relevant information when making treatment decisions that are safe and effective.
Non-estrogen birth control options, like the progestin-only pill, IUDs, barrier methods, and emergency contraception, are safer alternatives for individuals with a history of migraine with aura.

My first migraine with aura was in seventh grade. I’d had a sleepover with my best friend, Jessica, and we’d eaten donuts for breakfast. After her mom picked her up, I started feeling weird, spacy, sickly. Soon, I couldn’t see and my hand was numb. My head started to pound. I was having trouble forming words to describe my symptoms. My mom put me to bed and called our pediatrician. It was a Sunday, and there was a particularly bad flu that year. They told her to only call them if I stopped breathing. I threw up and felt okay after. I stayed home from school the next day and didn’t have any more symptoms. We chalked it up to a bug.

But then it happened again. And again. Sometimes only one side of my body would go numb. I couldn’t swallow pain pills at that age and couldn’t feel my tongue anyway. I had aphasia (a loss of ability to understand speech) and the pain was worse than a normal tension headache.

My migraine diagnosis

I went back to the pediatrician after the third incident and she told me my headaches were classic migraines and the vision issues were an aura. The aura looks different for each person and, at least for me, looks different each migraine, but the basic idea is that you have too much blood rushing to your head and it impedes your vision. There are two main kinds of aura with migraine: positive symptoms (flashing lights, spots, lines, pins, needles) and negative symptoms (numbness, hemi-paralysis, visual loss). For me, it looks like the visual imprint when you look at backlit Venetian blinds or when you accidentally stare into the sun’s reflection in a shiny object. Learning to identify an aura was key to figuring out what was going on with me.

“Migraine headaches are the third most prevalent illness in the world,” explains Queen Buyalos, R.Ph., creator of Mommy Queendom. “Low estrogen or high estrogen can cause migraines.” Because mine had an aura, they were likely caused by high estrogen.

I was prescribed the migraine medication Imitrex (sumatriptan) in different forms over the years, but the one that is dissolvable on the tongue was the one I took most frequently. Caffeine or over-the-counter caffeine pain killers like Excedrin often made the symptoms less severe if I took it early or chugged a cup of black coffee.

Uncovering a dangerous combination—migraine with aura and estrogen-containing birth control pills

In college, I went on a birth control pill (that contained estrogen and progesterone) and took one brand or another for the next 10 years. By now, my childhood friend Jessica was in med school and called me one day in a panic.

“Do you still get migraines with aura?” she asked.

“Yes.”

“Do you still take birth control pills with estrogen?”

“Yes.”

“You need to get off those immediately. You could have a stroke.”

I thought she was being dramatic. There’s this thing called student doctor syndrome where med students think they or their loved ones have the diseases they’re studying. But, just in case, I mentioned it at my next gynecologist appointment.

Sure enough, I should not have been taking hormonal birth control with estrogen. I’d had a grandparent on each side die of stroke-related complications and still occasionally got migraines with aura. Jessica knew all of this family and personal health history and potentially saved my life. I was at high risk for a stroke now or in the future.

“The estrogen component of the contraceptive poses a risk for the individual because it can induce and exacerbate menstrual/hormone-related headaches as well as makes the blood more easily clot,” explains Christina Madison, Pharm.D., an associate professor of pharmacy practice at the Roseman University of Health Sciences – College of Pharmacy. “This is of particular risk for persons with a history of migraine headaches with aura (the most severe form) because it can cause worsening of the condition and increase the risk of stroke.” Estrogen containing contraception is only contraindicated in the case of migraine with aura. Common migraine, or migraine without aura, is not a contraindication for contraception that contains estrogen.

My student health center had prescribed the estrogen-containing hormonal birth control in the first place and probably hadn’t caught the history of migraine with aura. It’s possible I hadn’t mentioned it since I didn’t know it was a relevant detail. I’m sure I hadn’t mentioned the family history of stroke in my intake. I was slightly concerned, though, that none of my doctors had caught it since. This is just one example of how important it is to share a complete family and medical history with all of your healthcare providers—especially gynecologists.

As it happened, I was visiting my gynecologist to talk about next steps before getting pregnant, so I simply stopped taking that form of hormonal birth control when my cycle ended and got pregnant quickly.

Migraine-safe birth control options

After my daughter was born, I visited my primary care provider to discuss all of my options now that birth control with estrogen was no longer an option.
She said I could take the progestin-only pill (sometimes called the POP of mini pill) without worrying about stroke; however, I’d learned that the POP was somewhat particular in that you have to take it at the same time every day or else it’s not effective.

If that’s a worry for you, there are many non-estrogen forms of birth control that are safe for those who have migraines with aura including:

A copper or progestin IUD, the best long-acting reversible contraception (LARC) option according to my doctor
Barrier methods, such as condoms, spermicides, or cervical caps
Progestin implant
Progestin injection or “shot”
Emergency contraception, often known as Plan B

Furthermore, for women who have migraine with aura, pregnancy is riskier for stroke or other thromboembolic event than any form of birth control, so it is important to prevent unintended pregnancy.

Dr. Madison says: “Those options that don’t require daily dosing are usually the best option i.e., LARC. These products also have immediate return of fertility if you want to get pregnant. The best contraceptive product is the one you take as directed.”