Yaz and Migraines
The effects of Yaz birth control on migraine headaches
Yaz® and Yasmin® are two birth control pills used by millions of women. Both include estrogen and drosperinone, a progesterone-like substance. Both have been marketed as treatments for premenstrual dysphoric disorder (PMDD) and for moderate acne, in addition to preventing unwanted pregnancies, which accounts for their wide popularity. Multimillion dollar advertising campaigns directed at women under the age of 35 have contributed to about $1.8 billion in worldwide sales in 2008.
However, headache is a frequent side effect of oral contraceptives that include estrogen and progestin. This is not surprising, since changes in estrogen levels can cause both menstrual migraines and menopausal migraines in women who are susceptible to them. Headaches result from sudden decreases in estrogen levels. However, even among women who are menopausal, replacing estrogen doesn't predictably improve migraines; nearly a quarter of women receiving estrogen replacement therapy experience worsening headaches.
In addition, PMDD can cause premenstrual migraines, and early pregnancy can increase migraines for many women. The link between sex hormones and migraines accounts for the greater prevalence of migraines in women; 25% of women will experience a migraine headache during their lifetime, compared to 8% of men.
Women who have menstrual migraines are more likely to experience migraines if they start taking oral contraceptives. Women who have migraines without auras generally experience less of a problem with worsening headaches while taking birth control pills than do women who have migraines with aura.
However, even more important than avoiding the pain of migraine headaches are safety issues associated with oral contraceptives. There is an association between migraine headaches, oral contraceptives, and an increased risk of stroke.
Most women who have migraine without aura can safely take birth control pills containing a low dose of estrogen, provided they don't have any other risk factors, such as high blood pressure, heart disease, excess weight, and/or diabetes. In contrast, women who are under the age of 35 who have migraine headaches with auras, even in the form of mild visual disturbances that last less than an hour, have a risk for stroke of about 30 in 100,000 annually. This is twice the risk of women the same age who have migraine without aura or no migraines at all.
The use of birth control pills should be considered carefully in women who have migraines with aura. Women who have more pronounced aura symptoms, such as trouble speaking, weakness on one side, or numbness that lasts longer than an hour, should avoid using birth control pills with even a very low dose of estrogen. Other options include birth control pills with progestin only, as well as other forms of contraception.
All women, particularly those with migraines, should avoid smoking cigarettes. Women with migraines who smoke one or more packs of cigarettes a day increase their risk of stroke tenfold.
When considering the use of Yaz® birth control pills, it's critical to weigh the benefits of preventing pregnancy against potential side effects, such as increased headaches and, for women who have auras before or with their migraine headaches, increased risk of stroke.