Hormonal birth control can make migraine better, worse or no different, depending on the person and the type ¹.

Migraine with aura and estrogen

Migraine with aura is linked to a modestly higher risk of ischemic stroke. Estrogen-containing contraceptives can add to that risk, and smoking increases it further ^2,3. For this reason, European headache and contraception experts advise that women with migraine with aura generally avoid combined estrogen-containing contraceptives and consider progestogen-only or non-hormonal options instead ².

Oral contraceptives have also been studied in relation to other types of stroke ⁴.

What this means for you

• Tell your prescriber if you have migraine, and especially if you have aura.
• If you are a smoker with migraine, quitting is one of the most important steps for your long-term health.
• Never stop or switch birth control without talking to your prescriber.

The absolute risk for most young women is low, but it is an important part of an informed decision.

Research cited on this page

1. Sacco S, Ricci S, Degan D, et al. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13(3):177-89. PubMed 22367631 · DOI
2. Sacco S, Merki-Feld GS, Ægidius KL, et al. Effect of exogenous estrogens and progestogens on the course of migraine during reproductive age: a consensus statement by the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESCRH). J Headache Pain. 2018;19(1):76. PubMed 30171365 · DOI
3. Allais G, Chiarle G, Sinigaglia S, et al. Estrogen, migraine, and vascular risk. Neurol Sci. 2018;39(Suppl 1):11-20. PubMed 29904828 · DOI
4. Xu Z, Yue Y, Bai J, et al. Association between oral contraceptives and risk of hemorrhagic stroke: a meta-analysis of observational studies. Arch Gynecol Obstet. 2018;297(5):1181-1191. PubMed 29460112 · DOI