From the Guidelines
Progestin-based birth control is generally considered safe for women with migraines, and it is recommended that women with migraines without aura can safely use any progestin-only methods. These methods are also safe options for women who experience migraines with aura, unlike combined hormonal contraceptives containing estrogen, which should be avoided in this group due to increased stroke risk 1. Progestin-only methods work by thickening cervical mucus, thinning the uterine lining, and sometimes preventing ovulation. Some women may experience changes in bleeding patterns when using progestin-only methods, ranging from lighter periods to irregular spotting or no bleeding at all. If migraine symptoms worsen after starting a progestin method, consulting a healthcare provider is recommended to discuss alternative options.
Key Points to Consider
- Progestin-only pills (like Micronor, Camila, or Norethindrone 0.35mg taken daily at the same time) are safe options for women with migraines.
- Hormonal IUDs (such as Mirena, Kyleena, or Skyla) are also safe options for women with migraines.
- The implant (Nexplanon) is a safe option for women with migraines, but there is limited data on its use in this population.
- Injectable progestin (Depo-Provera given every 3 months) may not be the best option for women with migraines due to concerns about thrombogenicity 1.
Important Considerations
- Combined hormonal contraceptives containing estrogen should be avoided in women with migraines with aura due to increased stroke risk 1.
- Women with migraines without aura can safely use combined hormonal contraceptives, but the risks and benefits should be carefully considered 1.
- Progestin-only methods are widely accepted as a lower-risk option in patients for whom estrogens are contraindicated but who still need effective contraception 1.
From the FDA Drug Label
If you have a headache or a worsening migraine headache with a new pattern that is recurrent, persistent, or severe, this requires discontinuation of oral contraceptives and evaluation of the cause.
Progestin-based birth control may not be suitable for women with migraines, as it can cause a worsening of migraine headaches. The FDA drug label recommends discontinuation of oral contraceptives if a woman experiences a worsening migraine headache with a new pattern that is recurrent, persistent, or severe. 2 2
From the Research
Progestin-Based Birth Control for Women with Migraine
- Women with migraine can consider progestin-based birth control as a safer alternative to combined hormonal contraceptives (CHCs) 3, 4.
- Progestin-only contraception does not seem to be associated with an increased risk of venous thromboembolism (VTE) and ischemic stroke, making it a better option for women with migraine 3.
- Studies have shown that progestin-only pills, such as desogestrel 75μg, can have a positive effect on migraine symptoms, reducing the number of days with migraine, the number of analgesics, and the intensity of associated symptoms 3, 5.
Comparison with Combined Hormonal Contraceptives
- Combined hormonal contraceptives (CHCs) may be used in the majority of women with headache and migraine, but they carry a small, but significant vascular risk, especially in migraine with aura (MA) and migraine without aura (MO) with additional risk factors for stroke 3, 4.
- Progestin-only contraceptives, on the other hand, can be safely used in women with migraines, including those with migraine with aura 4, 6.
Effectiveness of Progestin-Only Pill for Migraine Treatment
- A systematic review and meta-analysis found that the progestin-only pill (POP) containing desogestrel 75μg significantly reduced the number of migraine attacks and migraine days, and improved headache-related quality of life 5.
- Another study found that the use of progestogen-only pill in migraine patients can be a safe and effective alternative for contraception 7.