Q&A with Cove: Birth Control and Migraines Explained

This article was written in partnership with Cove. Read more about migraines and birth control on their site, here. 

Up to 37% of American women of reproductive age suffer from migraines — that’s a whole lot of aching heads, not to mention the nausea and other symptoms that typify migraines. The hormonal shifts of the menstrual cycle often play a role in migraines, but the relationship is complicated and often misunderstood.

That’s why we turned to Dr. Philip Bain, the Medical Advisor at Cove – a  healthcare company that helps migraine sufferers get the personalized, affordable care and support they need – to answer our most pressing questions about the overlap between female hormones and migraine.

How can you tell if you’re experiencing a migraine vs another type of headache?

The easiest way to figure out if your headaches are migraine (versus another type of headache) is by using a common screening tool called ID Migraine. If you have headaches and answer “yes” to at least 2 of the 3 following questions, there is a high likelihood that the headaches are migraine:

• Has a headache limited your activities for a day or more in the last three months?
• Are you nauseated or sick to your stomach when you have a headache?
• Does light bother you when you have a headache?

Is there a difference between migraines triggered by hormones and other kind of migraines?

No, other than that hormonally triggered migraine headaches are often more predictable. For example, someone with hormonally triggered migraine might say, “They occur every month, 2 days before my period starts.”

What’s the difference between a migraine with aura and a migraine without aura?

A migraine aura is a sensation (usually visual) that some patients with migraine get. Auras can manifest as brief flashes of light, zig-zag lines, black holes in your vision or distorted shapes. Other non-visual auras can include numbness and tingling, difficulty with speech, and odd smells.

Auras are seen in about 1 in 3 people with migraine. They can occur before every migraine headache or only prior to some migraine headaches. Auras can occur as often as several times a week or as rarely as once a year. They generally occur about an hour before the onset of head pain and tend to last less than 60 minutes.

It seems like some types of hormonal birth control make migraines better, and some makes them worse, is that true?

Hormonal-based contraception typically has estrogen, progesterone or both. These hormones regulate the menstrual cycle and pregnancy.

The brain of a migraine patient prefers stability – this is particularly true in regards to estrogen levels. For example, when estrogen levels are stable, the headache pattern is usually better. When estrogen levels change such as right before a menstrual period, headaches worsen.

Hormonal contraception methods, such as birth control pills, patches or vaginal rings, may change existing headache patterns — headaches may improve, worsen, or stay the same. It is very difficult to predict whether they will harm, help or not affect the headache pattern at all.

[Note from Nurx: Birth control that contains estrogen isn’t a safe choice for women who experience migraine with aura, because estrogen may raise their risk of stroke. For these patients, our medical team usually recommends progestin-only pills or the birth control shot.]

Do migraines usually take a multi-pronged approach to fix?

Yes, and having a consistent strategy is the best approach. Those with migraine should pay close attention to their lifestyle and any modifications. I recommend those with migraine get plenty of sleep (at least 8 hours is best), go to bed and wake up at the same time, don’t get dehydrated, don’t skip meals, reduce stress, minimize alcohol consumption, exercise regularly (at least 20 minutes on 5 or more days per week), and be sure to have your medications handy – one for nausea if you get nauseated with your headaches, a NSAID like ibuprofen or naproxen if you can tolerate them, and a triptan like sumatriptan if you can tolerate it as well. Keeping track of your headaches with a headache diary or tracker is also very important as it can help you identify patterns and triggers.

Do people who experience migraines have a greater risk of other types of health issues?  Do they have less risk of other health issues?

Many patients with migraine have other medical conditions that are seen in greater numbers than those who don’t have migraine headaches. Common conditions that often go along with migraine include depression, anxiety, stroke, irritable bowel syndrome, seizures and high blood pressure.

Nurx now provides migraine treatment — answer questions about your health and submit a few short videos and our specially trained medical team will prescribe migraine medication (if appropriate) and we’ll deliver it to your door. If you experience migraine and want to find a birth control method that is safe for you and might even improve your migraines, we can help with that too.

This blog pro­vides infor­ma­tion about telemed­i­cine, health and related sub­jects. The blog content and any linked materials herein are not intended to be, and should not be con­strued as a substitute for, med­ical or healthcare advice, diagnosis or treatment. Any reader or per­son with a med­ical con­cern should con­sult with an appropriately-licensed physi­cian or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.