Effects of Migraine and Contraception
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Some women find that their headaches and migraines improve when they start the pill; others notice that their headaches and migraine get worse. Studies suggest that headaches are less likely to occur with the lowest dose pills (20 micrograms of oestrogen) containing newer types of progestogens but this is not the same for everyone. It is important to find the pill that suits you best. This type of contraceptive pill is made up of a combination of a particular type of oestrogen, called ethinyloestradiol, and a particular type of progesterone, called progestogen. The Pill was introduced over 40 years ago, and the amount of hormones is now much lower than in the past . This has meant that unwanted effects like headaches and migraines, are much less likely to occur when they take the Pill. However, for many women their migraine attacks become more severe or frequent during the week they do not take the Pill. This is because the hormone levels drop at this time. The drop in oestrogen can trigger the migraine. If you get migraine with aura you should not take the combined oral contraceptive Pill. This is because the combined pill is associated with a very small increased risk of ischaemic stroke. This risk increases when the Pill is taken by women who have additional risks for stroke, such as smoking and migraine with aura. Statistics show that the risk is extremely small but never-the-less it is still a risk, which can be avoided. The risk from the Pill is due to ethinyloestradiol, and not progestogen. So progestogen-only contraceptives are a safer alternative. Some of these are more effective contraceptives than the combined Pill.
An increase in migraine frequency several years after starting HCs is more probably associated with independent, non-hormonal triggers. Headache that is related to combined HCs use generally is precipitated by estrogen withdrawal during the pill-free or placebo pill week of treatment and causal relationship is probably more definite when attacks occur regularly during hormone-free interval. Continuous treatment may ameliorate attacks occurring in the pill-free or placebo pill interval of treatment. There are no studies which have addressed whether changing from migraine without aura into migraine with aura, associated with initiation of combined HC, is associated with an increased risk of vascular events including ischemic stroke. However, there are some old data, from studies of high-dose combined HCs, which suggest that the development of migraine aura in women using those compounds correlates with increased platelet activation (Fritsche G, Hueppe M, 2007).
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