Birth Control Pills: Managing Migraines and Hormonal Effects

Oral contraceptives

Hello, my last menstrual period was on April 3rd, and I had a medical abortion on May 19th.
I returned for a follow-up on June 5th, and the doctor confirmed that everything was cleared.
The doctor recommended that I take birth control pills and prescribed Wenbunin T28 for me.
I started taking them on June 14th.
After taking six pills, I experienced a severe headache on the morning of the seventh day, which was a migraine accompanied by blurred vision.
I have a history of aura migraines, but they are not frequent; previously, they would occur due to excessive fatigue or just before my period.
However, in the last two years, I have had fewer than three episodes.
Today, the pain lasted for over six hours, and I took a pain reliever.
I found online that people with migraines should avoid birth control pills.
I want to know if my recent late nights and hormonal fluctuations triggered the migraine, or if it is due to the high dosage of the birth control pill.
I read that some say this brand is a high-dose first-generation type, while others claim it is a new type.
Should I stop taking the pills and return for an evaluation to consider switching to a lower-dose third or fourth-generation birth control pill, or should I avoid taking birth control pills altogether for contraception?

88, 20~29 year old female. Ask Date: 2018/06/20

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The last menstrual period was on April 3, and a medical abortion was performed on May 19.
During a follow-up visit on June 5, the doctor confirmed that everything was cleared and recommended starting birth control pills.
I began taking the Warm Infertility T28 on June 14.
After taking six pills, I experienced severe headaches on the morning of the seventh day, which were migraine attacks accompanied by blurred vision.
I have a history of aura migraines, but they have not occurred frequently, typically triggered by excessive fatigue or just before menstruation.
However, in the past two years, I have had fewer than three episodes.
Today, the headache lasted over six hours, and I took a pain reliever.
After researching online, I found that individuals with migraines should avoid birth control pills.
I would like to know if my recent late nights and hormonal fluctuations triggered the migraine, or if it is related to the high dosage of the birth control pill.
I found conflicting information online, with some stating that this brand is a high-dose first-generation type, while others claim it is a new type.
Should I stop taking the medication and return for an evaluation to consider switching to a lower-dose third or fourth-generation birth control pill, or should I avoid using birth control pills altogether in the future? Answer: It is advisable to stop the medication and return for an evaluation.

Reply Date: 2018/06/20

More Info

When it comes to understanding the relationship between birth control pills, migraines, and hormonal effects, it’s essential to consider several factors that can influence your experience, especially given your history of migraine with aura.
Firstly, hormonal contraceptives, including birth control pills, can indeed affect migraine patterns. For individuals with a history of migraines, particularly those with aura, the use of estrogen-containing contraceptives can increase the risk of stroke and may exacerbate migraine symptoms. This is particularly relevant for first-generation pills, which tend to have higher estrogen doses compared to newer formulations. The T28 pill you mentioned may fall into this category, depending on its specific formulation.

The onset of your migraine after starting the pill could be attributed to several factors:
1. Hormonal Fluctuations: Birth control pills work by altering hormone levels in the body, which can lead to changes in migraine frequency and intensity. If you have a history of migraines, especially those triggered by hormonal changes, starting a new contraceptive can potentially provoke an episode.

2. Sleep Patterns: You mentioned that you have been staying up late. Sleep deprivation is a well-known trigger for migraines. The combination of hormonal changes from the pill and lack of sleep could have contributed to the severity of your migraine.

3. Medication Side Effects: Some individuals may experience side effects from birth control pills, including headaches or migraines. If the pill you are taking is indeed a higher-dose formulation, it could be more likely to trigger these symptoms.

Given your situation, it is advisable to take the following steps:
- Consult Your Healthcare Provider: It’s crucial to discuss your migraine history and the recent onset of severe headaches with your doctor. They can evaluate whether the current birth control pill is appropriate for you or if a lower-dose formulation or a different type of contraceptive (such as progestin-only pills or non-hormonal methods) might be more suitable.

- Monitor Symptoms: Keep a detailed record of your migraine occurrences, including their frequency, duration, and any potential triggers (like sleep patterns, stress, diet, etc.). This information can help your healthcare provider make a more informed decision regarding your contraceptive options.

- Consider Alternatives: If your migraines continue to be problematic with hormonal contraceptives, you might want to explore non-hormonal methods of birth control, such as copper IUDs or barrier methods, which do not carry the same risks associated with hormonal fluctuations.

- Lifestyle Adjustments: In addition to medication considerations, addressing lifestyle factors such as sleep hygiene, stress management, and hydration can also play a significant role in managing migraine symptoms.

In summary, while birth control pills can be an effective means of contraception, they can also have complex interactions with migraine disorders. Given your history and the recent migraine episode, it is prudent to consult with your healthcare provider to reassess your contraceptive method and ensure it aligns with your health needs. Your well-being should always come first, and there are various options available that can help you manage both your contraceptive needs and migraine symptoms effectively.

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