Contraceptives

Do oral contraceptives cause headaches? The accurate answer is both YES they can and NO, they can actually ‘improve’ them.

Women suffer from headaches and migraines more than men do, this fact may not surprise you, especially if you are a young mother juggling two full time jobs (isn’t rearing children and housekeeping a full time job?) and striving to be the ‘perfect lover of the year’ as well! However, a large majority of women take oral contraceptives and about 20% of them attribute their headaches to the pills.

Stress causes headaches but there was evidence early on, when the pills contained much higher doses of estrogen, of a direct relationship between combined oral contraceptives (containing estrogen and progestin) and headaches in some women. Estrogen seems to be the culprit here so doctors reduced the dose of estrogen but as headaches are caused by all sorts of reasons this did not guarantee success.

There is also evidence that oral contraceptives can ‘ improve’ a woman’s migraines by reducing the attacks or the severity of the migraine, especially if she gets ‘ovulation’ headaches.

Ovulation Headaches

If you are not taking the oral contraceptive pill you may still get headaches with your period or when you ovulate. You may find that taking oral contraceptives will help to reduce the number of headaches you get.

Estrogen Withdrawal Headaches - or Menstrual Migraines - Headaches that occur during the 7 day placebo pill period

For those of you who are sure that the oral contraceptive you are taking causes your headaches, have you noticed if your headache/migraine occurs during the days you are taking the ‘dummy’ pills that do not contain any hormones? Just before you start your period, your natural estrogen level drops. Taking estrogen in your oral contraceptive pill for 21 days then NONE at all for 7 days, causes a sudden fall in estrogen levels during the last week of your menstrual cycle- this sudden drop may trigger a headache or a migraine. A good treatment for this, according to Dr. Rick Jelovsek MD, is Mircette, which has a low dose (10mcgm) of estrogen in each of the 7 day off pills OR…….

Your doctor may be able to prescribe a course of oral contraceptive pills that is ‘active’ every day for 9 weeks, then you take a week’s break of dummy pills. Or he may prescribe a progestin only pill for you.
If you take an oral contraceptive pill and your headaches worsen, you should not continue to use the same pill. Switching to a different pill, with different content, from a different manufacturer, may solve the problem. If not, it is likely that your GP will advise you to stop taking birth control pills completely.

If you have a History of Migraines

Risk profiles for women age 20-44: (www.virginia.edu/studenthealth/OCP%20and%20Migraine%20Headache.pdf)

• A woman with a history of migraine has a 4 fold increase in her risk of stroke compared to her peer who does not have migraines, or 16 to 20 strokes per 100,000 women with migraine per year.
• If the same woman with migraines uses a low-dose estrogen-containing birth control method, her risk for stroke is increased by 7 fold to 28 to 35 strokes per 100,000 women with migraines who use low-dow estrogen-containing birth control pills per year.
• The woman who has migraines, uses an estrogen-containing birth control method, and smokes has a 34 fold increase in her risk of stroke, or 134 to 170 strokes per 100,000 smokers with migraines on birth control pills per year.

For the above reasons, it is strongly recommended that if you have a personal or family history of migraine headaches, you should select non-estrogen methods of contraception. Your doctor should be able to advise you about the alternative options.

It is a case of trial and error - so if one brand of contraceptive pill gives you a migraine, changing to another brand, with your doctor’s approval of course, may not have the same effect. You may just need a pill with a lower dose of estrogen or you may find that your body will only tolerate ‘progestin only’ pills. If the headaches still continue, your health care provider may take you off the birth control pill and suggest that you use another type of contraception.

Headaches can also be a prior warning of an impending stroke or other circulatory disorder. Pay close attention to headaches that are different or more severe than those you had before starting on the Pill.