Around 15 percent of the U.S. population currently experiences migraine headaches, which affect both genders and all age groups. In children, similar numbers of boys and girls suffer from the disorder, while after 65 years of age the headaches diminish equally in both genders. During the reproductive years, however, women make up more than twice the number of patients than men, and hormones are believed to be a major reason for this.
The Role of Hormones in Migraine
Studies show two-thirds of female patients develop migraines around the time of monthly menstruation. This happens so often it has even been labelled a menstrual migraine. Scientists differentiate between “pure” menstrual migraines that happen over the same time frame as the menstruation, and menstrually-related headaches that occur before the onset of the period. Although most patients also get attacks at other times of the month, there’s enough evidence to show that female hormonal activity affects migraine sufferers significantly.
Taking Oral Contraceptives
The invention of oral contraceptives offered modern women a much easier way to avoid pregnancy, but it also brought with it an array of new problems for some patients to deal with. Most oral birth control products contain estrogen and progestin, the two primary female sex hormones. These work by preventing the ovaries from releasing eggs, and by changing the uterus lining to block the entry of sperm.
The Connection Between Hormones and Migraine
It’s fairly clear that these sex hormones and the chemical and physical processes our bodies use to create and absorb them all have a widespread effect on reproductive-age women. And since oral birth control methods contain the same hormonal ingredients, it makes sense that using them will have a similar impact. Some patients have a higher sensitivity to hormonal fluctuations than others, too. Research shows migraine can be triggered by decreased estrogen levels, both before the start of the period, and in the last phases of the menstrual cycle.
Identifying the Cause
Experiencing hormonally-related headaches doesn’t necessarily mean your oral contraceptives cause the migraines. If you suffer from migraines at any time of the month, keeping a comprehensive record will help you to identify your triggers, and to determine whether your attacks are impacted by hormones. Tracking your symptoms, dates, times, activities, weather and food consumption will help you and your doctor to spot common patterns, and determine whether the attacks are connected to your menstrual periods.
Birth Control Options for Migraines
A reliable birth control method is just as important for migraine patients as it is for non-migraineurs, so it’s essential that you find an option that works for you.
If your preference is for oral contraceptives, ask your doctor whether a combination pill could be suitable for you. In patients who experience headaches at the beginning of their period, combination pills might actually help reduce the frequency and severity of migraines by preventing the rapid drop in estrogen. This isn’t a solution recommended often, however, because the combination pill carries a risk of making the migraines worse, or causing a stroke.
Your doctor might recommend a progestin pill instead, which works for many women, although some patients find it causes erratic bleeding that can in turn trigger more migraine headaches.
Low-Dose Estrogen Supplement
Another potential option is to replace the 7 inactive or placebo pills in the monthly pack with a low-dose estrogen pill, which prevents the sudden drop in hormone levels that can cause the pure menstrual migraine.
For migraine patients with general hormonal problems, the solution could be a copper intra-uterine device (IUD), which contains no hormones whatsoever. This device disrupts the process of egg division and causes the body to develop an immune response that makes the environment hostile for sperm, to prevent fertilization. It’s easy to insert and remove, safe to use for 10 years and has been shown to be effective for 20 years, and reduces the risk of pregnancy by more than 99 percent.
Birth control methods have come a long way in the past few decades, but because of the hormonal component oral contraceptives often aren't ideal for migraine sufferers. If you find yourself dreading a migraine attack particularly around your period each month, it could have something to do with the contraception you're using. Even if your attacks aren't caused by birth control, they can well be made worse by it.