Migraines & Hormones (for those who suffer from Auras)

“Due to the preponderance of evidence that migraine with aura is associated with an elevated stroke risk compared with migraine without aura, and the assumption that this risk would be further elevated by use of estrogen-containing contraceptives, the American College of Obstetricians and Gynecologists (ACOG) and the WHO have considered migraines with aura to be an absolute contraindication to the use of combined hormonal contraception.” (Ref 1)

I started getting migraines with auras during my senior year of college. The first time it happened, I thought I was going blind. I was trying to put my make-up on before class and I couldn't see my own face in the mirror. It seemed everywhere I looked, things became blurry. I got to my classroom and had to take a scan-tron test (remember those?). I am not sure I was able to fill in the circles with my pencil. I headed straight to our school medical center. The doctor told me that my pupils were dilated and I was having a migraine. She put me in a dark room and told me to rest. 

Flash forward ten years and we are in the process of our recent move. I got three migraines with auras within a week. The worst of which began while I was on the highway driving with my daughter and dog in the car. I had to pull over and rest for an hour. Luckily my husband was able to get me some Migraine medicine and soda and bring it to me. But I got really scared. I had read somewhere that more migraines with auras mean increased risk of stroke later in life. So I made an appointment with a neurologist. This appointment cost me $225, so I want to share what I learned to make the most of the money I spent. 

{This post is not meant to replace medical advice, please consult your doctor if you have any concerns about your current health situation, and prior to taking, or stopping any medications}

During a migraine with aura, you may see flashing, zig-zags, or be partially blinded. For me, it starts as a small blinking spot that slowly takes over most of my field of vision. I close my eyes and try to breathe slowly, as my eyes feel like they are running a marathon. I cannot stand chevron patterns on carpets or any large surface- I feel like I am in the middle of a migraine! Here's a medical description of a migraine with aura:

Migraine With Aura (Previously Known as Complex Migraine) (Ref 1)
Migraine with aura has a 1-year prevalence rate of 5% in women. Aura specifically describes a complex of neurologic symptoms that occur just before or with the onset of migraine headache, and most often resolves completely before the onset of headache. Neurologists have long hypothesized that a phenomenon called cortical spreading depression (waves of altered brain function triggered by changes in cellular excitability) is responsible for migraine aura. Visual symptoms are the most common aura, and are a feature of 99% of auras. According to the ICHD II criteria, migraine with aura is a recurrent disorder manifesting in attacks of reversible focal neurologic symptoms that develop gradually over 5 to 20 minutes, and last for less than 60 minutes. Headache with the features of migraine without aura usually follows the aura, although less commonly, the headache may lack migrainous features or be completely absent.

My Neurologist did not recommend any preventative medication, but simply told me that migraines with auras occur when the body is low on energy. Not sleeping is NOT an option. I was provided with a medication to take at the onset of a migraine aura. Up until now I have been taking Excedrin Migraine, with a caffeinated beverage, and that was reducing any pain after the aura disappeared, but not reducing the auras. This new medication (a powder that I’ll mix with liquid), is supposed to reduce the aura. But the biggest thing is to PREVENT THEM FROM HAPPENING. Get Rest.

She explained some really important and interesting things about migraines with auras:
  • Migraines with auras are genetic. I do not know of anyone else in my family who gets these, but I am surely going to ask around now!
  • Migraines with auras are most similar to epilepsy (they are not the same, but similar - you can read more here: http://www.ncbi.nlm.nih.gov/books/NBK98193/)
  • People who get migraines with auras should NOT be taking combined hormonal contraception(see Ref 1)
  • People who get migraines with auras have a baseline risk factor for strokes. It's like being 50 years old, being a smoker, or having high blood pressure. She said I absolutely have to fight every other risk factor as I age as I do not want to have any more risk factors!

According to the CDC, here are some of the risk factors for stroke (Ref 2):
  • AGE (The chance of having a stroke about doubles every 10 years after age 55)
  • SEX (Although men are more likely have a stroke, women are more likely to die from one)
  • BEING A WOMAN (Use of birth control pills, pregnancy, history of preeclampsia/eclampsia or gestational diabetes, oral contraceptive use, and smoking, and post-menopausal hormone therapy may pose special stroke risks for women. Be sure to discuss your specific risks with your doctor.)

Let's take a further look at the risks associated with birth control / oral contraception (OC), auras, and strokes. This excerpt describes how your risk of stroke increases from 2.7 / 10,000 as a 25-29 year old woman, to 11 / 10,000 at the same age if you have migraines with auras, and 23 / 10,000 if you have auras AND use combination contraceptive. That is more than DOUBLING your risk!
The type of migraine is important when considering the risk of stroke. Women with migraine without aura have a low risk of stroke and venous thromboembolism (VTE), similar to women without migraine. Combination OC use increases a woman’s risk for VTE and ischemic stroke. Observational studies found 1-3 additional cases of VTE among 10,000 women taking combination contraceptives for one year. Taking into account a baseline 10-year ischemic stroke rate of 2.7 per 10,000 young women (ages 25-29) years, OC usage increases the risk to 4.0. The risk increases to 11.0 for women who have migraine with aura, and to 23.0 for women with migraine with aura using OCThe World Health Organization (WHO) recommends that women with migraine with aura avoid combination contraceptive use. The American College of Obstetricians and Gynecologists (ACOG) recommends using alternative forms of contraception in certain populations of women such as women over 35 years who smoke and women with migraine headaches. 

Always be completely honest and open with your medical professionals. The checklist of health conditions could be more important than you ever imagine. And if your OB/GYN professional is trying to prescribe you combination contraceptives and you have a history of migraines with auras, make sure that you discuss the risk factors. I was unaware of these until very recently and wish I had found out sooner. I am very thankful that nothing has happened to me. I hope this helps some of you make informed decisions in the future.

1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938905/
2) http://www.cdc.gov/stroke/risk_factors.htm
3) http://www.americanheadachesociety.org/assets/1/7/Susan_Hutchinson_-_Use_of_Oral_Contraceptives_in_Women_with_Migraine.pdf

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