The Pill and migraines: here's everything you need to know.

The last time I had my period I ended up in the emergency room. For hours before my boyfriend bundled me into the car and drove me to hospital, I was bent into a ball on my bed, the blinds were down, and I had my forehead pressed into a pillow. The pain was so intense that it felt like my skull would split open and, with every passing hour, I became more convinced that I was probably going to die like this, groaning in my novelty pyjamas. 

Eventually, it simply didn't feel humane to have to endure that much pain and I ended up in ER, where I explained, bleary-eyed and barely conscious, to a doctor, that I was experiencing an all-time migraine and they either need to give me some hardcore painkillers or simply put me out of my misery. They opted for the former and sent me home. 

I started having fairly regular migraines at about nine years old. I remember some days being shut in my dark bedroom, curtains drawn, with a pillow wrapped around my head until, eventually, I vomited violently into a pre-organised bucket and could emerge from my little cave. Once I started on the Pill at around 16, the migraines weren't so much of a problem anymore – except, that is, whenever I stop taking the Pill to have my period. Then, everything goes to shit. 

My brain slows down, I fatigue easily, and then, after two days or so, a migraine will hit me like a wall. Agreeing to have my allotted period on the Pill, and taking the sugar pills, basically means that I lose three days of my life to the worst pain I've ever experienced.

Whenever I have failed to organise myself and run out of my script, I will drive maniacally around the city trying to get a prescription as quickly as possible in order to keep my supply going, because I know that if I fail to take that little pink pill within 24 hours, my life will become utterly consumed by the migraine. 

But the relationship between the Pill and migraines is not the same for every woman and there is clearly a complicated connection at play between the two. 

Why is it that my Pill seems to prevent the onset of migraines – at least, until I stop taking it during the week I'm supposed to have my period – but for other women I've spoken to, taking the Pill seems to intensify the severity of their migraines? 

And, adding to the complexity of this conversation, for some women who experience migraines, taking the Pill may actually be dangerous. 

What is a migraine? 

This is probably the logical place to start. 

According to the advocacy group, Migraine Australia, migraines (or migraine attacks) are the product of "a very complex genetic neurological disorder". They're not simply 'bad headaches'. People who have migraines may experience pulsating headaches, nausea, vomiting, as well as sensory changes like becoming more sensitive to light or noise. 

In addition to this, about a third of migraine patients will experience 'aura', which is a range of neurological symptoms that occur early in the migraine attack. Some people may report visual symptoms – such as bright spots, lines, or changes in their field of vision – but there are other changes to taste, smell or hearing that can occur. 

Listen to the Quicky talk about why TikTok is encouraging women to stop taking the Pill below. Article continues after podcast. 

Less commonly, some people can experience slurred speech or an inability to form the right words as part of their migraine aura. In fact, back in 2011, Grammy reporter Serene Branson experienced this slurring speech in the middle of a live broadcast. The disturbing moment that she started stumbling over her words was initially thought to be a stroke by viewers but it was later revealed that Branson was experiencing migraine symptoms.

As for what actually causes migraines, this gets a little complex. 

Migraine attacks happen when the ions in a person's brain channels are travelling too quickly because the valves that control those channels become stuck open. The pain nerves in the head and neck become irritated, blood vessels in the head spasm, and inflammation occurs in the affected part of the brain. 

Doctor Bronwyn Jenkins, a neurologist who specialises in migraine, tells Mamamia that the searing pain that accompanies a migraine is caused by "hyperexcitable nerves firing off", specifically involving neurotransmitters that are involved in pain. And the problems with the hyperexcitability of the migraine brain compound that experience of pain. 

"The problem with our brains is that all of the nerves in the upper part of the neck, as well as any structure in the head, share one pain centre, which is a bit crazy, seeing as the brain is so important... that means that a lot of factors – whether it's glare from the lights, a stiff, sore neck or disorders of the jaw – can trigger off more headaches in someone who can get migraine," she says. 

Are migraines a women's issue? 

Migraines are, overwhelmingly, experienced by women. According to the advocacy organisation Migraine & Headache Australia, 71 per cent of migraine sufferers are women. 

This gender difference is because there are strong hormonal factors that contribute to migraine. In fact, Dr Jenkins says the main factor that contributes to the onset of migraine attack in women is a drop in oestrogen. 

"So, the reason that a lot of women have menstrually related migraine, which means migraine around the time of the start of their periods, is because that's the time when oestrogen is dropping," she says. 

This is also why women tend to experience migraines for the first time when they start menstruating or around the time of menopause. 

However, migraines can also because by too much oestrogen in the body. 

So, what's the deal with migraines and the Pill? 

There is no one-size-fits-all answer to this question, unfortunately. 

Dr Jenkins explains that many women will have harder-to-treat migraines when they experience a drop in oestrogen, which is why they will experience them over their menstrual period. 

When women, like myself, take the Pill, and then stop taking it over their allotted period time according to the Pill packet, they experience that drop in oestrogen, which continues to fall over subsequent days. 

Dr Jenkins says that for women who experience migraine like this on the Pill, at least there is predictability built into this cycle, which means that you have some semblance of control over when you might have a migraine attack and how to handle it. 

"Those people can have chosen the timing, to not time with their deadline or their holiday overseas or whatever things are important to them – and to be ready to take their medication knowing the exact day that their oestrogen is dropping, so that they can keep it under wraps," she says. 

Dr Jenkins says that most women within this group can safely just skip periods on their Pill cycle in order to avoid debilitating migraines (something that I have done for approximately a year now). 

But then, there's another group of women who will find that their migraines become much more severe when they're taking the Pill.

About a quarter of women are more likely to experience migraines when they are in, what Dr Jenkins calls, a 'high-oestrogen state", which is simply having more oestrogen in the body. For these women, taking the Pill can be problematic for their migraines and they may find that they become much worse and much more regular when they're on it.

Watch: Five things to know about migraines below. Article continues after video. 

For some people, taking the Pill when you have migraines can be risky. 

Something extremely important to keep in mind is that for some women who have migraines, taking the Pill is not advisable. 

For women who experience aura with migraines, that is, those sensory disturbances like flashing lights, changes in vision, hearing or feeling, it is not safe to take the Pill at all. 

Grace, tells Mamamia that she was on the Pill for three years experiencing migraine aura before a physician caught what was happening to her. 

"I was always getting flashes in my eyes, which I had seen multiple doctors and ophthalmologists about," she says. 

Grace went to about five different doctors and underwent multiple retina scans trying to assess what was wrong with her eyes – she didn't make the connection between her visual disturbances and the headaches that she lived with. She says it took a long time before somebody finally gave her an answer. 

"It was a new doctor doing a full history, as I was his new patient. I was there about something else and he asked me if I had headaches and I said, 'Oh yeah, like every day'. And that's when he started to dig. 

"He asked if I was on the Pill. He said to stop taking it immediately, as these symptoms were caused by the Pill and I was at risk of stroke. I went off it that day. I was prescribed another Pill but decided to never put anything like that in my body again." 

Dr Jenkins says that it's not hard to miss when people have aura with migraines, as the symptoms are quite distinct. And for those people, they cannot take the Pill safely. 

"When there's aura, that indicates that the arteries can change in size across the brain – and so, that group have a higher risk of clots and strokes when they're given a combined contraceptive Pill that contains a suppressive dose of oestrogen. So, we certainly avoid the Pill in that group with aura." 

Overall, the risk of experiencing stroke for women who have migraine with aura when they are on the Pill is approximately three times that for women who have migraine without aura who are on the Pill. 

How to treat migraines. 

Dr Jenkins says that we're well into the era of 'disease-specific treatment' and not just taking painkillers and lying in the dark until a migraine attack is over. 

Triptans are a family of drugs used to treat migraines that quieten down those overactive pain nerves and they're available over the counter in Australia. Certainly, Dr Jenkins says, people can use icepacks and keep themselves hydrated but these medications are extremely useful for stopping the pain of migraines. 

"There's symptomatic treatments that people try but as far as our goal of stopping a migraine attack within an hour or two, the disease-specific treatments of triptans tend to be the most effective," she says. 

There are also preventive medications that can be taken for people who experience migraines regularly, so make sure you ask your doctor. 

The continuing frustrations for migraine sufferers. 

The shocking impact that migraines have on the lives of Australian women cannot be overstated. 

According to Migraine & Headache Australia, 86 per cent of people who experience migraines are of working age and the total economic cost of migraine (as in, the cost of the working hours lost to this debilitating condition) in Australia is about $35 billion every year. 

A continuing source of immense frustration for migraine sufferers like myself is the baffling lack of resources available to people who need specialist consultation. 

Dr Jenkins notes that the problem is deeply ingrained in the medical system. 

"We've done studies on this, that we have very little education in headache during our undergraduate and postgraduate years, even in my discipline of neurology. So, there's confusion about a lot of very clear cut and not very tricky things with migraine disorder still in general practice," she says. 

Dr Jenkins says she has seen GPs who think that all patients will experience worse migraine attacks when taking the Pill and GPs who believe that anyone with migraine is at high risk of stroke on the Pill, both of which are untrue claims. 

"The majority of women with migraine can use a contraceptive Pill safely for contraceptive and other hormonal reasons. And it can actually be quite helpful in skipping periods, choosing the timing and minimising the number of menstrual exacerbations they have to have each year," she says. 

Director of the Brain Foundation, a charity that funds research into migraine, Carl Cincinnato, tells Mamamia that there's a clear lack of neurologists in Australia who specialise in migraines, like Dr Jenkins. 

"If you look at how many people in Australia have migraines, that's 4.9 million, that works out to be something like 30,000 patients per specialist. So, chances are, you're never going to see a specialist for headache in Australia." 

Cincinnato also says that because migraines overwhelmingly affect women, there is clear-cut sexism contributing to this lack of education, understanding, and resources provided to treating them. 

"Women's pain is often minimised, is often treated less seriously than their male counterparts. Migraine itself has historically been seen as a women's disease and alongside hysteria and it's belittled because of that," he says. 

Dr Jenkins agrees that there are unavoidably sexist aspects to how migraine is treated on a broad scale. She says that migraine impacts "on young women to function at their peak productivity over years of their career, before menopause." 

To hear this, as a woman who suffers from migraine, who feels trapped on the Pill because of the threat of migraine, is a horrifying and infuriating realisation. My only comfort, really, is that there are strong advocacy groups in Australia fighting to make real systemic change for migraine sufferers. 

In the meantime, all I can do is stick to the Pill, voice my support for migraine advocacy, and get very, very angry any time I hear somebody refer to migraines as 'just a headache'. 

Elfy Scott is an executive editor at Mamamia. 

Image: Canva. 

TAKE SURVEY ➤