Migraine With Aura and the Pill: a Combination Worth Knowing

In brief

If your migraines come with an aura, an oestrogen-containing pill is a combination to avoid. Know which type you have.

Aura is the neurological warning some people get before a migraine: flickering or zig-zag lines, a blind spot spreading across vision, tingling in a hand or face, or trouble finding words, usually lasting up to an hour before the headache. It is a specific thing, and knowing whether your migraines have it matters more than most women are told.

Migraine with aura is associated with roughly double the risk of ischaemic stroke, a background risk that is small in young women but real. Combined hormonal contraception, the pill, patch, or ring that contains oestrogen, adds further to that risk. Stack the two and the risk multiplies, which is why guidelines advise against combined hormonal contraception in women who have migraine with aura.

The problem is that this often gets missed on both sides of the counter. Women are rarely asked precisely about aura when contraception is prescribed, and many do not know their own migraine type. Smoking and high blood pressure push the risk higher still.

If you have migraine with aura, it is worth raising directly with your doctor or pharmacist. Progestogen-only methods and non-hormonal options do not carry the same concern, so there are safe alternatives. This is a five-minute conversation that can matter a great deal.

Key Takeaways

• •Migraine with aura roughly doubles ischaemic stroke risk; an oestrogen pill adds to it.
• •Guidelines advise against combined hormonal contraception with migraine-with-aura.
• •Know your migraine type; progestogen-only and non-hormonal options are safer here.