From the Guidelines
The 17-year-old should stop the triphasic birth control immediately and contact their healthcare provider due to the development of migraines, which may indicate an increased risk of stroke, as supported by the American Academy of Pediatrics guidelines 1. The development of migraines after starting hormonal contraceptives, particularly those containing estrogen like triphasic pills, is concerning because it may indicate an increased risk of stroke. According to the guidelines, COCs should not be prescribed for patients with migraines with aura or focal neurologic symptoms 1. Some key points to consider in this case include:
- The patient should switch to a progestin-only method such as the mini-pill (norethindrone 0.35mg daily), a depo-provera injection (150mg every 3 months), or a hormonal IUD (like Mirena or Kyleena) to minimize the risk of stroke and other complications associated with estrogen-containing contraceptives.
- If the migraines include aura (visual disturbances, numbness, or speech changes), this is especially important as estrogen-containing contraceptives are contraindicated in patients with migraine with aura, as stated in the guidelines 1.
- While stopping the triphasic pill, the patient should use backup contraception like condoms until an alternative method is established to prevent unintended pregnancy.
- The connection between estrogen-containing contraceptives and migraines relates to estrogen's effects on cerebral blood vessels and neurotransmitters involved in migraine pathophysiology, highlighting the importance of careful consideration when prescribing hormonal contraceptives to adolescents with a history of migraines.
- The patient should also track their migraine symptoms to see if they resolve after discontinuing the triphasic pill, which would confirm the association between the hormonal contraceptive and the development of migraines, as suggested by the guidelines 1.
From the Research
Migraines and Triphasic Birth Control
- A 17-year-old starting triphasic birth control and developing migraines may be experiencing a common side effect, as hormonal contraceptives can affect migraine patterns 2, 3, 4, 5, 6.
- The available scientific literature indicates that combined hormonal contraception, such as triphasic birth control, is safe for most headache subtypes, but should be avoided in women with migraine with aura and those with simple migraines who have other risk factors for stroke 2.
- Progestin-only contraceptives, as well as the copper intrauterine device, can be safely used in women with migraines, and may even have a positive effect on migraine patterns 3, 4, 5.
Effect of Progestin-Only Contraceptives on Migraines
- Studies have shown that progestin-only contraceptives, such as desogestrel, can reduce the number of migraine attacks and migraine days, as well as improve headache-related quality of life 3, 4, 5.
- A retrospective pilot study found that a desogestrel progestogen-only pill led to a statistical reduction in migraine days, headache days, pain intensity, and use of medications, compared to continuous combined oral contraception 5.
Clinical Considerations
- Hormonal contraceptives, including triphasic birth control, may be used in women with migraine, but it is essential to accurately classify the patient's headache type to avoid unnecessary restriction of effective contraceptive methods 2, 6.
- Women with migraine without aura may benefit from the use of progestin-only contraceptives, which may improve migraine patterns and reduce the risk of vascular events 4, 5.