Since its introduction in the 1960s, hormonal contraception has transformed women's lives by giving them control over their fertility. However, like any treatment, it has some potential side effects and risks. For women with migraines , choosing the right contraceptive method can be particularly tricky.
Indeed, the link between migraines and contraception is not always simple: some methods can aggravate symptoms, while others, on the contrary, could alleviate them. How do you know which contraception to choose when you have migraines? Are there safer and more suitable options? And above all, how can you avoid worsening migraines while still benefiting from effective contraception?
The combined pill: benefits and risks
Combined hormonal contraception, which combines estrogen and progesterone, is an effective and beneficial method for many women. However, its impact on migraines is complex and can vary considerably from person to person. For some women, the combined pill may improve migraine symptoms , while for others it may worsen them, or have no effect. In practice, worsening of migraines is reported in 18 to 50% of cases, mainly in those with migraines with aura. Conversely, a reduction in symptoms is observed in 3 to 35% of cases, while for 39 to 65% of women, no significant change is observed.
Although these hormonal contraceptives can be used in a majority of women with migraine or headaches, they nevertheless present significant risks. There is mainly a vascular risk , small but significant, especially in those suffering from migraines with aura. Indeed, it has been established that the risks of deep vein thrombosis, myocardial infarction and ischemic stroke are two to six times greater than when using a progesterone-only oral contraceptive. This danger is also present, although to a lesser extent, in women with migraines without aura, particularly when they have additional risk factors such as smoking or hypertension.
Therefore, a safer alternative for women with migraines may be the use of progestin-only contraceptives.
The progestin-only pill: benefits and risks
Progestins, by inhibiting ovulation while stabilizing estrogen levels, may reduce the pain threshold in female migraineurs , which could decrease both the frequency and intensity of migraine attacks.
For example, the progestin-only pill desogestrel (75 μg) has demonstrated a favorable effect on the evolution of migraines with aura as well as migraines without aura. In the majority of women, it allowed a significant reduction in the number of migraine days, the use of analgesics and the intensity of symptoms. After three months of observation, the use of desogestrel showed a significant decrease in migraine attacks with aura and a reduction in the duration of aura symptoms. However, it is important to note that during the first 4 weeks of use, the frequency of migraines may increase slightly before improvement.
Furthermore, progestin-only contraception does not appear to carry any risk of venous thrombosis, stroke or cardiovascular complications , unlike estrogen-progestin contraception.
Current guidelines therefore recommend progestin-only contraceptives as a safer option, particularly for women with migraine with aura and, possibly, migraine without aura.
How to reduce risks?
Although zero risk does not exist, certain precautions can help prevent them as best as possible. The first step towards appropriate contraception in the event of migraines is to establish good communication with your doctor . Regular monitoring and sharing of information allow the professional to develop a personalized treatment that takes into account medical history, lifestyle, specific risk factors, etc. This monitoring also allows the treatment to be adjusted, whether it is to modify the doses or opt for a different contraceptive method, in order to benefit from the advantages while limiting the side effects . It is also crucial not to change treatment without medical advice.
Additionally, for women whose migraines are sensitive to hormonal changes, non-hormonal contraceptive methods such as condoms or copper intrauterine devices represent an interesting alternative. These solutions do not influence hormonal levels and therefore reduce the risk of migraine exacerbation. They also avoid the complications and adverse effects associated with hormonal contraceptives.
At the same time, given the disabling nature of migraines, the treatment of these symptoms should not be neglected. Preventive treatments https://naturveda.fr/collections/traitement-de-la-migraine/products/migspray-traitement-migraine can thus be useful to reduce the intensity and frequency of attacks, thus providing valuable support on a daily basis.
Don't trivialize your pain
By living with recurring pain, some people may be tempted to minimize it or adapt to it without seeking adequate solutions. However, pain is above all a warning signal from the body.
Migraines with aura, in particular, can sometimes present with symptoms that resemble those of a transient ischemic attack (TIA) or stroke, such as visual disturbances or numbness. This is why it is important for people with migraines with aura to see a doctor if they experience new neurological symptoms , such as changes in vision, numbness, muscle weakness, or difficulty speaking. If these symptoms persist for more than an hour, or are different from the usual aura, urgent medical attention is required to assess the situation and prevent any risk of stroke.
In summary, the choice of contraceptive method in women with migraine is a real challenge, requiring a personalized and rigorous approach. Migraines can be a significant source of discomfort and incapacity, making the balance between effective contraception and optimal management of migraine symptoms all the more crucial. In this context, progestin-only contraceptives appear as a safer alternative to reduce vascular risks while providing potential relief from migraine attacks. Furthermore, the management of migraines themselves should not be underestimated either.
