Migraines with aura


#1

I have been on Microgynon for the past 16 years with no problems. I once had the implanon implant but after 6 months bled continually and had to take cerrazette at the same time so they removed it. I have also tried to mini pill and bled continually on that too. I have had 3 migraines with aura in the last three years and my GP refused to prescribe the combined pill. I will not have the coil for personal reasons and feel I am being forced in to that decision. I really want to continue with microgynon and feel it is my decision as I understand the risk. I have considered the injections but am struggling to tell if that is the same hormones as the implant and mini pill and if I am likely to bleed with that too.


#2

Hi @Sphe

Many thanks for your post. This is an interesting issue on two counts. First why migraines are a problem and second what should we do as clinicians if you know the risk but still want to continue.

You probably already know this - so mainly if anyone wants to know. Migraines are an unusual type of headache. Usually the pain is one sided and may be associated with nausea and dislike of light. Aura is a change in sensation that happens usually before the pain of a migraine headache starts. It can take many forms but often involves visual disturbance for example bright lights, loss of part of the vision., zig zag lines.

This is a drawing of one person’s experience of aura: https://en.wikipedia.org/wiki/Aura_(symptom)#/media/File:Migraine_aura.jpg

Migraines with aura are a problem because they involve a disturbance of the blood supply to your brain. In this situation there is some constriction of some of the blood vessels in your brain so that the blood flowing in them flows more slowly. Blood that flows slowly also clots easily. The combined pill increases that risk of clotting. The problem is that a blood clot in the brain is extremely serious - basically it is a stroke. So it is the seriousness of the possible outcome that is the important issue here. Even though most people will not get a stroke, a few people will. The World Health Organisation Lists this as a category 4 contraindication. That means that the WHO recommends that people who have migraine with aura should definitely not be prescribed the combined pill.

The next thing to think about is what should health professionals do if you explain that you know about the risk but you are happy to take it. What do others think?

The final thing to think about is - is there really not an alternative method that would suit you. Migraine with aura means that you probably should not take any combined method (including the pill or vaginal ring or patch. Injections can cause irregular bleeding during the first few months. Most people are not bleeding at all after 1 year, but a few people (1%) get ongoing irregular and troublesome bleeding. Injectables contain the same type of hormone as implants and POPs but it is a different version of that hormone.

Paula


#3

Hi @Sphe, I am in the same place as you I think, I was happy on the combined pill for years but since I had a migraine with aura, my GP said I can’t use any combined hormonal methods ever (unless…she said if I don’t have a aura for 5 years, she may reconsider…)

Although I am gutted I am now unable to control my periods like before…I was freaked out enough about the increased risk of stroke to stop taking COC.

I’ve been on the cerelle mini POP for 3 months, the first 6 weeks were a bleed free & headache free dream, this last 6 weeks have been the opposite… I also think its making me more spotty and greasy…How long did you stay on the mini POP for?
I’ve got a GP review on Friday, and I think I’ll give POP another 3 months to see if things settle.

If not, I was going to consider the injection… I saw on here that there is a self-injectable option, which whilst sounds a bit scary, sounds better than having to get GP appointments every couple of months!

Sorry you feel forced into a decision. Due to the increased risk maybe it is worth trying the other options first? I get it though, the implant and injection seem to be the two that get the most mixed reviews…

good luck. mol