Migraine and the Contraceptive Pill: Will It Help, Make It Worse, or Rule the Pill Out?
How the pill can change your migraines, which headaches after starting are expected and which are not, pill-free week migraine, the mini pill, and how migraine medicines such as triptans and topiramate fit with contraception.
Part of the Complete Migraine Guide.
Key fact: Having migraines does not automatically rule out the pill. The deciding question is whether your migraines come with aura. With aura, the combined pill is not used because of stroke risk, but progestogen-only methods are. Without aura, the combined pill can usually be started — and for some women it actually reduces migraine, while for others the pill-free week is the trigger.
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Around one in three people with migraine experience aura: temporary visual, sensory or speech symptoms that build up gradually over several minutes, last up to an hour, and usually come before the headache. Zigzag lines, a shimmering blind spot, or pins and needles spreading up one arm are typical. Aura matters for contraception because migraine with aura is itself linked to a small increase in the risk of ischaemic stroke, and oestrogen adds to it.
| Your migraine | Combined pill, patch or ring | Progestogen-only methods and coils |
|---|---|---|
| With aura, now or in the past five years | Not used: the risk is considered unacceptable | Can be used |
| Aura only more than five years ago | Generally not recommended; needs individual assessment | Can be used |
| Without aura | Can usually be started; review if migraines worsen on it | Can be used |
This page deliberately keeps the aura rules short, because they are set out in full in contraception and migraine with aura, including how to tell aura from other visual symptoms and every alternative method. What aura looks and feels like is described in migraine with aura. Be precise about your own history when asked: a blurred vision or flashing lights during the headache itself is not the same as aura, and the distinction changes what you can use.
How the pill can change your migraines
Migraine is closely tied to oestrogen — not to its level so much as to falls in it. That is why migraine often clusters around periods, improves in later pregnancy, and can change around the menopause. The combined pill alters that pattern, and it can go three ways.
| Pattern | What is happening | What to do |
|---|---|---|
| Migraines improve | The pill replaces your natural monthly oestrogen swings with steady levels for three weeks | Nothing, other than keeping an eye on any change |
| Migraines cluster in the pill-free week | The sudden drop in oestrogen when the active pills stop triggers attacks | A tailored regimen with fewer or no breaks often helps (below) |
| Migraines become more frequent or severe overall | Some women are sensitive to the hormones themselves | Review the method. Under UK eligibility criteria, migraine that develops or worsens on the combined pill is a reason to reconsider continuing it |
A headache diary over two or three packs is the most useful thing you can bring to a review. Mark the days of each attack and the days of the pill-free break, and the pattern usually becomes obvious.
Headaches after starting the pill
Mild headaches are a common side effect in the first two or three months of any new pill, and they often settle as the body adjusts. The question is whether a headache is the ordinary kind, or a warning sign.
| Usually expected | Not expected: stop and seek advice |
|---|---|
| Mild, dull headaches in the first few months, easing over time | Aura appearing for the first time, or aura becoming more frequent |
| Your usual migraine pattern, unchanged | Migraines becoming markedly more frequent or severe |
| Headaches mainly in the pill-free week | A sudden, severe headache unlike any before |
| A persistent headache with raised blood pressure, or with visual disturbance that does not resolve |
New aura on a combined pill means stop it. If you develop aura for the first time while taking a combined pill, patch or ring, stop it, use condoms, and speak to a pharmacist, GP or sexual health service within a few days. Do not just switch to another combined brand. A progestogen-only method can usually be started straight away.
Migraine in the pill-free week
Headache or migraine that starts within a few days of stopping the active pills, and clears once the next pack begins, has a recognised name: oestrogen-withdrawal headache. It is the commonest pill-related migraine pattern, and it is very treatable if your migraine is without aura.
The withdrawal bleed in the pill-free week has no health benefit, and UK guidance supports taking the combined pill in ways that reduce or remove the break. The main options are:
| Option | How it helps |
|---|---|
| Taking packs back to back | Running three or more packs together, or taking the pill continuously, removes most or all of the monthly oestrogen drops. See taking pills back to back |
| A shorter break | A four-day rather than seven-day break shortens the low-oestrogen window |
| Short-term preventive treatment around the break | A longer-acting triptan or an anti-inflammatory taken over the days of the break, prescribed for predictable attacks. Covered in the menstrual migraine guide |
Spotting is common when you first run packs together and usually settles. If your migraine comes with aura, none of these apply: the issue is then the oestrogen itself rather than its fluctuation, and a progestogen-only method is used instead.
The mini pill and migraine
Progestogen-only pills contain no oestrogen, so they do not carry the stroke concern that rules out the combined pill with aura, and they are taken every day without a break. The desogestrel mini pill, such as Zelleta or Cerazette, also stops ovulation in most cycles, which smooths out the natural hormone swings.
Small studies suggest that desogestrel can reduce migraine frequency in some women, including some with aura, though the evidence is limited and it does not help everyone. The trade-off is bleeding: the mini pill commonly causes irregular, unpredictable bleeding, especially in the first few months. Starting the mini pill or switching from a combined pill is covered in mini pill or combined pill.
Migraine medicines and contraception
This is the part most often overlooked. Acute migraine treatments are generally fine with any contraception. Some preventive medicines, however, either reduce how well contraception works or must not be taken in pregnancy, which makes reliable contraception essential.
| Medicine | Effect on contraception | What it means for you |
|---|---|---|
| Triptans, such as sumatriptan, rizatriptan and zolmitriptan | No interaction | Can be taken with any pill, including if you have aura |
| Paracetamol, ibuprofen, naproxen, aspirin, anti-sickness medicines | No interaction | Can be taken with any method |
| Propranolol, amitriptyline | No interaction | Can be taken with any method |
| Topiramate | Can reduce the effectiveness of hormonal contraception, particularly at higher doses | Must not be taken in pregnancy. Since 2024, women who could become pregnant need highly effective contraception under a pregnancy prevention programme; a coil, or a barrier method alongside hormonal contraception, is usually advised |
| Candesartan (used off-label for prevention) | No interaction | Harmful in pregnancy, so effective contraception is needed |
| CGRP medicines, such as erenumab, fremanezumab, galcanezumab and atogepant | No known interaction | Avoided in pregnancy as a precaution, so effective contraception is advised |
| Sodium valproate | No reduction in pill effectiveness | Not used for migraine in women who could become pregnant unless under a pregnancy prevention programme |
If you are prescribed topiramate for migraine, make sure the prescriber knows exactly which contraception you use. A pill or implant on its own may not be enough. The wider list of medicines that affect the pill is in the pill and other medicines.
How the different triptans compare, including which suit fast-building attacks and which suit attacks that return, is covered in triptans for migraine.
Emergency contraception if you have migraine
Migraine, with or without aura, does not restrict emergency contraception. The levonorgestrel and ulipristal pills contain no oestrogen and are a single dose, so they carry none of the concerns of the combined pill. The copper coil is the most effective option and is hormone-free.
The exception is if you take a medicine that speeds up how the liver breaks down hormones, which can include higher-dose topiramate. Then the copper coil is preferred, or a double dose of levonorgestrel may be advised, and ulipristal is not recommended. Which option suits which situation is set out in emergency contraception compared.
Migraine, the pill and HRT later on
A common worry is that being told you cannot take the combined pill because of aura means you will not be able to take HRT at the menopause. That is not the case. HRT uses natural oestrogen at a much lower dose than the synthetic oestrogen in the pill, and migraine with aura is not a reason to avoid it. Oestrogen through the skin, as a patch or gel, is usually preferred because it gives steadier levels, which also suits migraine. Migraine in perimenopause, when hormone swings are at their most erratic, is covered in the menstrual migraine guide.
When to get help urgently
Call 999 for sudden weakness or numbness of the face, arm or leg, especially on one side; sudden difficulty speaking or understanding; sudden loss of vision; or a sudden, severe headache that peaks within a minute. Aura builds up gradually over minutes and resolves within an hour. Symptoms that come on abruptly, or persist, need emergency assessment whatever your migraine history.
See a GP or pharmacist promptly, rather than at your next routine review, if you develop aura for the first time on a combined pill, if your migraines change character or become much more frequent, if you have a headache with leg pain or swelling or chest pain on a combined pill, or if you need to use painkillers or triptans on more than about ten days a month, which can itself cause medication-overuse headache.
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See contraception options →Frequently Asked Questions
Can the contraceptive pill cause migraines?
It can. Mild headaches are common in the first few months of any new pill and often settle. Some women find their migraines become more frequent on the combined pill, or cluster in the pill-free week when oestrogen drops. New aura, or migraines that clearly worsen on a combined pill, are a reason to stop it and get advice rather than carry on.
Why do I get migraines in my pill-free week?
The sudden fall in oestrogen when you stop the active pills can trigger a migraine, known as oestrogen-withdrawal headache. If your migraine is without aura, taking packs back to back, shortening the break, or short-term preventive treatment around the break often helps. If you have aura, a progestogen-only method is used instead.
Does the mini pill help migraines?
For some women it does. The desogestrel mini pill contains no oestrogen, has no break, and stops ovulation in most cycles, which smooths out natural hormone swings. Small studies suggest it can reduce migraine frequency, including in some women with aura, but the evidence is limited and irregular bleeding is a common side effect.
Can I take sumatriptan while on the pill?
Yes. Sumatriptan and the other triptans do not interact with the combined pill, the mini pill or any other contraception, and they do not reduce its effectiveness. Triptans can also be used if your migraines come with aura.
Does topiramate stop the pill working?
It can reduce the effectiveness of hormonal contraception, particularly at higher doses. Topiramate must also not be taken in pregnancy, and since 2024 women who could become pregnant need highly effective contraception while taking it. A coil, or a barrier method used alongside hormonal contraception, is usually advised. Tell the prescriber exactly which contraception you use.
If I cannot take the combined pill because of aura, can I take HRT later?
Usually, yes. HRT uses natural oestrogen at a much lower dose than the synthetic oestrogen in the combined pill, and migraine with aura is not a reason to avoid it. Oestrogen given through the skin as a patch or gel is usually preferred because it gives steadier hormone levels.
References
- Faculty of Sexual and Reproductive Healthcare. UK Medical Eligibility Criteria for Contraceptive Use (UKMEC). fsrh.org
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Migraine. cks.nice.org.uk
- Faculty of Sexual and Reproductive Healthcare. Drug Interactions with Hormonal Contraception and Combined Hormonal Contraception guidelines. fsrh.org
- Medicines and Healthcare products Regulatory Agency. Topiramate: introduction of new safety measures, including a Pregnancy Prevention Programme (2024). Drug Safety Update. gov.uk
- British Association for the Study of Headache. National headache management system for adults. bash.org.uk
- Headache Classification Committee of the International Headache Society. International Classification of Headache Disorders, 3rd edition: exogenous hormone and oestrogen-withdrawal headache. ichd-3.org
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Whether a contraceptive is suitable depends on your migraine type, blood pressure, smoking and other medical history, and some migraine medicines interact with contraception or must not be taken in pregnancy. Always consult a qualified healthcare professional before starting, stopping or changing treatment. In a medical emergency, call 999.