Brief explanation

Which contraceptive methods are suitable for people with migraine depends primarily on whether they experience migraine with or without aura. For migraine with aura, combined hormonal contraceptives containing oestrogen are unsuitable because of the increased risk of stroke. For migraine without aura, they may be an option under certain conditions.

Alongside hormonal methods, there are also non-hormonal contraceptive options such as condoms, the copper coil or the diaphragm. Which method is suitable depends on the type of migraine, other health factors and personal needs.

Migraine with and without aura: What is the difference?

Migraine is a neurological condition often associated with recurrent headache attacks, nausea and sensitivity to light and sound.

In migraine without aura, the neurological symptoms typical of an aura do not occur.

In migraine with aura, temporary symptoms such as visual disturbances, flashes of light, tingling or speech difficulties may occur before or during an attack. An aura can also occur without a subsequent headache.

This distinction is important: migraine with aura is associated with an increased risk of stroke caused by a blocked blood vessel. Combined hormonal contraceptives containing oestrogen may further increase this risk. [2, 4]

Important: Sudden speech difficulties, signs of paralysis or other possible stroke symptoms require immediate medical attention.

Can hormones affect migraine?

Hormonal fluctuations can influence migraine attacks. Changes in oestrogen levels, in particular, play a role in some women.

One example is menstrual migraine, in which symptoms occur around the time of menstruation.

Hormonal contraceptives can also affect migraine. Symptoms may improve, worsen or remain unchanged. How women respond varies from person to person. [1]

Which methods of contraception are suitable for people with migraine?

Various methods of contraception may be suitable for those with migraine. Any medical restrictions depend in particular on whether migraine occurs  with or without aura.

Combined hormonal contraception

Combined hormonal contraceptives contain oestrogen and a pro

gestogen. These include the combined contraceptive pill, the vaginal ring and the contraceptive patch.

For migraine with aura, these methods are not suitable due to the increased risk of stroke.

For migraine without aura, they may be considered under certain conditions. Additional risk factors such as smoking or high blood pressure must be taken into account. [3, 4]

Progestogen-only contraception

Progestogen-only contraceptives do not contain oestrogen. Examples include the mini-pill, the contraceptive implant and the hormonal coil.

In principle, these methods may also be suitable for migraine with aura. However, whether they are suitable depends on other health factors and possible contraindications. [3]

Hormone-free contraception for migraine

Hormone-free contraceptive methods contain neither oestrogen nor progestogen. These include condoms, the diaphragm and the copper coil.

They do not introduce any additional contraceptive hormones into the body. The methods differ in terms of how they are used, their contraceptive effectiveness and any possible restrictions.

You can find out more about hormone-free contraception and its connection to sexuality and body image in our article ‘Hormone-free contraception: impact on libido, sexuality and body image’.

Medicines used to prevent migraine can also play a role in your choice of contraception. Special safety guidelines apply to the active ingredient topiramate, as its use during pregnancy is associated with significant risks to the unborn child. Highly effective contraception is required during treatment and for at least four weeks afterwards. You should consult your doctor to clarify which methods meet the applicable requirements. [5]

The diaphragm as a hormone-free method of contraception for migraine

The diaphragm is a hormone-free barrier method that is inserted into the vagina before sexual intercourse. It covers the cervix and, together with a diaphragm gel, forms a barrier against sperm.

As the diaphragm works without contraceptive hormones, it does not suppress ovulation. It is used as and when required and is reusable.

The diaphragm can be used regardless of the type of migraine. The relevant instructions for use and any individual restrictions should be followed.

You can find detailed information on how to use it under ‘How does the diaphragm work?’.

Further information on contraceptive reliability is available in our article ‘How reliable is a diaphragm? Effectiveness and use explained simply’.

Conclusion

When choosing a method of contraception, it is particularly important to distinguish between migraine with and without aura. Whilst combined oestrogen-containing contraceptives are not suitable for migraine with aura, other hormonal and non-hormonal methods are available.

The diaphragm is a non-hormonal barrier method and is used as and when required. Which method of contraception is suitable depends on your health and personal needs.

Note: This article is for general information purposes only and is not a substitute for individual medical advice. No contraceptive offers 100 per cent protection against pregnancy. The diaphragm does not provide reliable protection against sexually transmitted infections (STIs).