Birth control, headaches, and migraines: Why this happens

How are birth control pills and migraines connected?

Birth control pills and migraines are linked in more ways than one. For some, birth control pills can trigger migraines, while for others, they can make episodes less frequent. In addition, if you’re prone to migraines with aura (visual symptoms like flashes or vision loss), you should not use birth control pills that contain estrogen, as they can increase the risk of getting a stroke [1].

Combination birth control pills — the most common type of birth control pills — contain both estrogen and synthetic progesterone, and they work by stopping ovulation and making cervical mucus thicker so that sperm can’t survive. They often come in packets with three weeks’ worth of active pills followed by a week of placebo pills that don’t contain any hormones. When estrogen levels drop during the placebo week, it can trigger a migraine [2]. To understand why this happens, let’s take a look at the relationship between hormones and headaches. 

What’s the link between hormones and headaches?

Headaches can be caused by a number of different reasons, ranging from the common cold to neck tension from sitting in front of a computer all day. But did you know that some types of headaches are actually linked to our hormones? Headaches are more common at certain stages in life when hormone levels tend to shift, for example, during puberty, perimenopause, or in early pregnancy. They are also closely related to our menstrual cycle [2].

What are hormonal headaches?

Hormonal headaches are headaches triggered by hormonal changes. The most likely cause is the drop in estrogen levels right before our period begins, but there’s also some evidence suggesting that other hormones, like prostaglandin, may be involved as well. Often, these headaches are actually migraines, and they are also referred to as menstrual migraines or period headaches. They typically start in the two days before or during the first three days of period bleeding. As many as 50 to 60 percent of women with migraines have noticed that these episodes are linked to their period [2].

While it’s mostly migraines that are linked to hormonal changes, some studies indicate that other types of headaches, like tension headaches, may be influenced by hormones as well, since they are more common in women than men. However, more research is needed in this area [3]. 

Headache vs. migraine 

It’s important to distinguish between headaches and migraines, especially when it comes to treatment options. Migraines are thought to be caused by unusual brain activity that affects blood vessels and nerve signals. Symptoms include headaches that are often one-sided, throbbing or pulsating pain, sensitivity to light, sounds, or smell, fatigue, and nausea. Migraine attacks typically last between 4 and 72 hours [4]. In some cases, there are also visual symptoms, like seeing bright flashes or shapes, or even temporary vision loss, before the headache itself actually starts — this is called migraine with aura [5].

Other types of headaches can feel similar to migraines, but there are some differences that tell them apart. For example, the pain during a tension headache (one of the most common types) is usually felt on both sides of the head. It’s often less severe than a migraine and goes away if the tension is resolved [4]. 

How do I know if I have menstrual migraines?

Migraines have many triggers, and it’s not always easy to make the connection that they can be related to your hormones (after all, we don’t tend to measure our hormone levels regularly). Many who suffer from headaches during their period are also not aware that what they experience is a menstrual migraine (as opposed to a “regular” headache), which means that this condition is underdiagnosed [2].

Keep an eye on the timing of your headaches. Do you notice a pattern in when they start? Menstrual migraines happen when there’s a certain shift in hormone levels, whether it be just before or during your period or during the break between packets if you’re on hormonal birth control. Keeping a migraine diary can help you understand the timing of your symptoms, and tracking your menstrual cycle, for example with Natural Cycles or a period app, or where you’re at in your pill packet at the same time may help you identify a connection. It’s also a good idea to speak with your doctor to figure out what type of headache you’re experiencing and the best course of treatment. 

Can birth control cause headaches or migraines?

The short answer is: yes, birth control can cause migraines and headaches, especially for those who are already prone to migraines or are sensitive to hormonal shifts [6]. 

Hormonal headaches and migraines are mostly associated with birth control that contains estrogen, which includes the combination pill, birth control patch, and vaginal ring. These also have another thing in common: there are breaks built-in when using them, which means that you’ll have a few weeks of steady hormone levels followed by a short period of no hormones. It’s during this time, when estrogen levels drop, that migraines tend to happen. This situation is similar to menstrual migraines caused by the drop in estrogen right before our period starts when not on hormonal birth control [7]. 

Headaches are also a common side-effect when first starting hormonal birth control, such as the combination pill. This is likely related to the change in hormone levels as the body adjusts to the additional hormones, and the headaches should get better after a couple of months [8]. 

What should I do if my birth control causes migraines?

If you suspect that your birth control is causing migraines, you should reach out to your healthcare provider to discuss the best course of action. It can also be helpful to keep a headache diary, which can help you spot patterns and come prepared for the meeting with your doctor.

Because migraines often happen during the break from hormones when using combination birth control, your doctor may suggest skipping the break entirely. If you’re on the pill, that means that you’d simply start the next pill packet right away without taking the sugar pills. Similarly, with the birth control patch, you would just put on a new one right away without a break in between. There are also some options that have less frequent breaks. It’s always worth checking with your doctor if you’d like to give those a try; it’s safe but some may experience irregular bleeding or breakthrough bleeding.

You may also want to look into switching to another form of birth control. There are many options out there, but for those prone to migraines as a birth control side-effect, it can help to switch to a progestin-only contraception (like the mini pill or IUD) since this eliminates the fluctuations in estrogen levels. There are also hormone-free options available if you prefer to avoid hormones altogether.

Can birth control relieve migraines?

To make matters more complicated, birth control can also help if you suffer from menstrual migraines. The menstrual cycle comes with its own hormonal shifts — there’s a peak in estrogen levels around ovulation and a drop in estrogen right before our period starts. Birth control keeps hormone levels steady throughout the month, so those who are prone to migraines around their period may find that their symptoms decrease or go away completely while taking hormonal contraception.

If the routine break from hormonal birth control triggers migraines, there are also birth control options that don’t have any placebo days (like the hormonal IUD or implant). Even on the pill, you may be able to skip the placebo week — speak to your doctor if you have questions or want to change the way you use your current contraception.

Lastly, since estrogen is the hormone most closely linked to migraines, there are also options that only contain synthetic progesterone. These are less likely to trigger migraines and may be a good alternative for those who have symptoms when using combination birth control like the pill [6].

Choosing a birth control method that’s right for you

Many factors go into finding the best contraception, and our needs often change over time. Side effects are one of the reasons to consider when switching birth control, and if you suspect that your birth control is worsening your migraines, these are some alternatives you can look into:

• Natural Cycles: A non-hormonal option, Natural Cycles is an app powered by an algorithm that identifies your daily fertility status based on body temperature and optional ovulation tests. You’ll get Red Days when you’re fertile and need to use protection, and Green Days when you’re not fertile. Natural Cycles is 93% effective with typical use and 98% effective with perfect use.
• Progestin-only birth control: Because headaches related to hormonal birth control are often caused by a drop in estrogen, switching to progestin-only contraception can help. Options include the mini pill, birth control shot, and birth control implant. 
• Condoms: One of the most used types of birth control, condoms are a convenient option for many. They’re easily available, non-hormonal, and protect against sexually transmitted infections (STIs). Condoms are 87% effective with typical use and 98% effective with perfect use.
• Copper IUD: Another non-hormonal option, the copper IUD is a small, T-shaped device that’s inserted into the uterus. This long-acting birth control works for up to twelve years depending on the brand. It prevents pregnancy mostly by preventing the movement of sperm and the implantation of a fertilized egg, and it’s over 99% effective. 

It’s always a good idea to speak with your healthcare provider if you’re thinking about switching birth control. They can help you determine which option is best for you with your migraines in mind.

Hear from our community

"After being told that my headaches in my 'pill-free' weeks were actually being caused by said pill, I cut it out immediately and didn't even finish the pack! Why should I have to suffer?

My friend at the time told me about NC so I decided to give it a go.

I have now been off it for 4 years, and it's been life-changing. I feel more in touch with my emotions, I know my cycles better than I ever have done and the knowledge I have gained about my body has been a really positive journey for me." - Becka (NC° Birth Control user)

When to see a doctor

Headaches can be debilitating, whether it’s a migraine or another type of headache, so it’s important to seek help from a healthcare professional if you have headaches that impact your daily life or cause you to miss out on things you enjoy, work, or time with family and friends. You should also see a doctor if:

• Your symptoms become worse or change suddenly
• Your headaches are accompanied by other symptoms like dizziness, vision loss, confusion, or numbness in your limbs
• You have a migraine that lasts longer than 72 hours
• You have migraines frequently

How to treat hormonal headaches 

Luckily, there are several ways to treat headaches and also some things you can do to prevent or limit them. The first thing to do is determine what type of headache you have since treatment options will differ — keeping a headache diary and tracking symptoms gives you a good foundation for speaking with your doctor. For example, migraines may warrant a certain treatment plan, while tension-type headaches are managed differently.

Medical treatment for menstrual migraines

Before starting any medical treatment, it’s important to speak with your doctor to find the best options for you. Some common treatments that your doctor may suggest are [2]:

• Mefenamic acid: A medication that can be used to prevent migraines, especially those that are associated with periods. You can start taking them a couple of days before your period starts to prevent the headache from developing.
• Triptans: Another medication that your doctor may prescribe to help prevent migraine episodes. Similar to mefenamic acid, you start taking it a couple of days before a migraine is expected to start.
• Estrogen supplements: For some people, estrogen supplements can be used around their period to limit the drop in estrogen levels that often trigger migraines. This option is not suitable for everyone, for example, those at risk for breast cancer, so make sure to speak with your doctor if you’re interested in this option.
• Hormone replacement therapy (HRT): Migraines often become more frequent as we enter menopause, so HRT can be a helpful treatment for some since it reduces hormonal fluctuations that trigger migraines.
• Hormonal birth control: Hormonal birth control helps keep hormone levels more steady throughout the month compared to the natural fluctuations that happen during the menstrual cycle. Skipping or reducing the number of hormone-free days can also help reduce headaches triggered by the change in estrogen levels. Even though hormonal birth control can worsen headaches and migraines for some, it’s a viable treatment option for others. 

Because some of these treatments are more effective if you start taking them before your period even starts, you may also find it useful to track your cycle so that you know when your period is coming and can prepare for it ahead of time.

Lifestyle changes to help menstrual migraines

Even if your migraines are related to the use of hormonal birth control or the hormonal changes that happen before your period, there are many other things that can trigger migraines as well, including stress, skipping meals or not drinking enough fluids [2]. You can consider some lifestyle changes that can help you manage headaches and may even make them less frequent.

• Manage stress levels: Stress is a common cause of migraines (and other types of headaches), so taking steps to limit stress in day-to-day life may help improve things. Practicing mindfulness or relaxation techniques has been shown to be effective in managing migraines [9].
• Prioritize sleep: Sleeping too much or too little can trigger migraines in some people [10], and a number of sleeping-related issues (like insomnia and sleep apnea) have also been linked with migraines. Focusing on sleep hygiene, for example, by limiting screen time before bed, keeping a cool and dark bedroom, and sticking to a regular sleep schedule, can help reduce the severity of headaches and make migraines less frequent [9]. 
• Eat regularly: Skipping meals or going too long without eating can trigger migraines for some people (and even if you don’t have migraines, you may feel a headache coming on if you go too long without food). It can help to eat regularly and have smaller snacks in between meals to keep from getting too hungry [2].
• Limit certain foods: Some foods, like chocolate and MSG (monosodium glutamate), are viewed as classic triggers for migraines. However, research into these foods has found varying results, and more studies are needed [9]. This may also be individual, so if you notice that you get headaches after eating chocolate or MSG (or other foods), you can try cutting them from your diet for a while and see if it makes a difference for you.
• Drink less coffee: Caffeine is another classic migraine trigger, so limiting caffeine may help keep them at bay. However, headaches are a symptom of caffeine withdrawal as well, so you should try to decrease your caffeine intake slowly and not stop all at once [10].
• Limit alcohol: Many people who suffer from migraines report alcohol, especially red wine, as a trigger, so you can try limiting your alcohol intake to see if it helps. The relationship between alcohol and migraines isn’t fully understood, and more research is needed in this area, but one study looking specifically at low doses of alcohol found that drinking didn’t trigger migraines [11]. 
• Exercise: Regular exercise is not only good for our overall health — research also suggests that it can help make migraines less frequent, less severe, and even make them last for a shorter time [9]. Try to find a form of exercise that you enjoy, whether it be jogging, yoga, or a gentle walk.

Understand your hormones better with Natural Cycles

At Natural Cycles, we’re passionate about giving you the knowledge you need to take charge of your health. The first and only FDA Cleared birth control app, NC° Birth Control lets you prevent pregnancy without hormonal side effects. You can also track other cycle-related symptoms, like headaches, and the app will let you know which symptoms you usually experience at each point in your individual cycle so that you can prepare accordingly. Why not check out if Natural Cycles could be right for you today?