Can Birth Control Pills Prevent Menstrual Migraines?

woman taking birth control pill
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Menstrual migraines are those that occur in the days before or after your period. While scientists are not completely sure why there is an association between migraines and menstruation, there is strong evidence that fluctuating levels of estrogen, a hormone that regulates the menstrual cycle, are involved. For this reason, birth control pills, which prevent these hormonal fluctuations, are often prescribed to prevent menstrual migraines.

Types of Menstrual Migraines

There are two sub-types of menstrual migraines: Menstrual-related migraines and pure menstrual migraines, with the former being more common than the latter.

Symptoms of menstrual-related migraines include:

  • migraine headache without aura that occurs one to days before or after the onset of your period and occurs in more than 60 percent of your cycles
  • Migraines with or without aura that occur at other times in your cycle

Symptoms of a pure menstrual migraine include:

  • A migraine headache without aura that occurs exclusively during the one or two days before or after the onset of your period and occurs in more than 60 percent of your cycles

The Role of Estrogen

Researchers have found a strong connection between estrogen and menstrual migraines. Typically, higher estrogen levels prevent migraines, whereas lower levels can trigger them. But it may be more the fluctuation or change in estrogen that triggers a migraine, not simply the fact that the level is low.

A woman’s estrogen levels drop to their lowest point right before menstruation, and this is usually the time that migraines are most likely to occur.

One theory is that the drop in estrogen right before menstruation excites the brain regions that are involved in a migraine, triggering an attack. This is supported by the fact that women with migraines tend to get more migraines in perimenopause—a period of time prior to menopause when a woman's estrogen levels fluctuate.

Likewise, during the second and third trimester of pregnancy, many women obtain migraine relief, which is again attributed to the naturally high levels of estrogen in a woman's body. 

Up to 60 percent of women with migraines say they experience them around the time of menstruation.

How Birth Control Pills May Help

Menstrual migraines tend to be more severe and less responsive to both the acute and preventive medications that are typically used to treat attacks that occur at other times of the month.

For some women, taking a continuous combination birth control pill—which consists of both estrogen and progestin—can reduce the frequency of attacks. These pills inhibit ovulation (the trigger for the hormone changes) and maintain estrogen levels by eliminating the hormone-free week associated with the cyclic use of the birth control pill.

With the continuous pill, you take the pills continuously to keep your estrogen levels constant. This means skipping the placebo pills if you have a 28-day pill pack, or taking a pill every day (no skipping needed) if you have a 21-day pill pack.  

Another option is a progestin-only pill, also called the MiniPill. These pills prevent pregnancy by thickening the cervical mucus, making it much harder for sperm to swim through. Progestin-only pills are prescribed for women who should not take pills containing estrogen, such as women who smoke, have high blood pressure, a history of blood clots, or migraine with aura during times of the month. For women in this category, estrogen can increase the risk of stroke.

Birth control pills can also be used in combination with triptans and other medications typically prescribed for migraine. Avoiding migraine triggers, such as stress, lack of sleep, or irregular eating, is another useful prevention strategy.

A Word From Verywell

Every woman responds to hormones differently, and there are side effects and contraindications involved in using birth control pills that may make it an inappropriate treatment in some cases. Some women benefit from using birth control pills, some do not, and others may even experience worsening of their migraines.

Your doctor may ask you to keep a diary of your attacks for several months, noting each time you experience a migraine and the dates of your menstrual flow. This can help her determine if you do, in fact, have menstrual migraines, and decide on the best treatment strategy going forward.

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