Hormonal Treatments: Can Birth Control Help Menstrual migraine attacks?

Hormonal fluctuations are one of the most common triggers of menstrual migraine attacks among women. Since the main cause is estrogen withdrawal during a period, using birth control or other hormonal therapies to keep the hormones constant may be helpful. However, not all hormonal therapies are suitable for every woman, including those with migraine with aura. In this article, we will look at how various hormonal strategies can influence menstrual migraine attacks and what factors to consider when developing a treatment plan.

How Hormones Affect Menstrual Migraine Attacks

Estrogen is a hormone that is involved in brain function, and changes in level can cause migraine attacks. Right before menstruation, estrogen levels decrease, which leads to menstrual migraine attacks. Researchers have established that maintaining more constant levels of estrogen can prevent migraine attacks during periods.

Understanding Typical vs. Brainstem Aura

Migraine aura refers to neurological symptoms that precede or accompany a migraine attack. These can include visual disturbances, sensory changes, or speech difficulties. However, aura can be categorized into two types:

• Typical Aura: Typically consists of visual, sensory, and/or speech/language symptoms. Visual symptoms can include flashing lights, zigzag lines, or temporary vision loss.  Sensory symptoms can include numbness or tingling on one side of the body, and speech/language symptoms can include difficulties with speaking or understanding speech. These symptoms usually last between 5 to 60 minutes and resolve completely.
• Complex Aura: Includes more severe neurological symptoms such as prolonged visual disturbances, difficulty speaking, numbness, or muscle weakness that can last longer and resemble stroke-like symptoms. Complex aura may indicate a higher risk of complications when using estrogen-based contraceptives.

Hormonal Birth Control Options for Migraine Management

Several hormonal birth control methods can help regulate estrogen levels and potentially reduce migraine frequency and severity:

Continuous Low-Dose Birth Control Pills

• Ideal for women who do not experience migraine with aura.
• Prevents estrogen withdrawal by eliminating the hormone-free interval (skipping placebo pills).
• May reduce or eliminate menstrual migraine attacks over time.

Estrogen Patches or Gels

• Provides a steady estrogen dose, helping to prevent the rapid drop that triggers migraine attacks.
• Can be used in the days leading up to menstruation to counteract estrogen withdrawal.

Vaginal Ring (NuvaRing)

• Can be used continuously (replacing it every three weeks instead of taking a week off) to maintain stable hormone levels.
• Reduces fluctuations that might contribute to migraine attacks.

Who Should Avoid Estrogen-Based Contraceptives?

Women who experience migraine with complex aura are generally advised to avoid estrogen-containing contraceptives due to an increased risk of stroke. In these cases, non-estrogen options may be preferable:

Progestin-Only Options

• Progestin-only pills (mini-pill) – Safer for women with aura but may not provide the same estrogen stabilization benefits.
• Hormonal IUDs (e.g., Mirena, Kyleena) – Provide localized progestin with minimal systemic hormone fluctuation.
• Depo-Provera Injection – A long-acting progestin method that may help some women reduce menstrual migraine attacks.

Non-Contraceptive Hormonal Approaches

For women who do not need birth control but want hormonal migraine relief, estradiol supplementation can be considered:

• Estradiol patches or gels applied in the days leading up to menstruation.
• Compounded bioidentical hormones customized to an individual’s needs.

Risks and Considerations

• Increased stroke risk: Women with migraine with complex aura should be particularly cautious with estrogen-based treatments.
• Side effects: Some women experience nausea, bloating, or breakthrough bleeding with hormonal therapies.
• Trial and error: Finding the right hormonal approach often requires working closely with a healthcare provider.

When to Seek Medical Advice

If menstrual migraine attacks are severely impacting your life, discussing hormonal treatment options with a health care provider is essential. A healthcare provider can evaluate your risk factors and recommend the safest and most effective approach.

Disclaimer

This article is for informational purposes only and should not be considered medical advice. If you experience menstrual migraine attacks or other severe headaches, consult your healthcare provider for a proper diagnosis and treatment plan. To explore treatment options, consider booking an appointment with Haven Headache for expert guidance and personalized care.