Key Takeaways:

• Migraine with aura involve neurological warning signs like visual changes or tingling before the headache phase.
• Estrogen-containing contraceptives can increase stroke risk in people with migraine with aura, even at low doses.
• Progestin-only birth control options such as the mini-pill, hormonal IUDs, and the implant are generally safer alternatives.
• Non-hormonal methods, like the copper IUD, are effective and avoid hormonal triggers altogether.
• Consulting with your provider before making any decisions about birth control is especially important if you experience migraine with aura. 
• Tracking migraine patterns in relation to your menstrual cycle can help guide the best birth control choice.
• Lifestyle factors, cardiovascular health, and age influence which contraceptive options are safest.
• Open conversations with healthcare providers ensure personalized, safe, and effective birth control planning.

Migraine with aura and birth control options

If you experience migraine with aura, it can make choosing birth control feel more complicated.

Aura symptoms—like flashing lights or vision changes—are more than just uncomfortable; they also play an important role in determining which birth control methods are safe. That’s because certain contraceptives, especially those containing estrogen, may raise the risk of stroke in people who experience migraine with aura.

The key is finding options that protect against pregnancy while also keeping your overall health in mind. Progestin-only methods are often considered safer choices for people with migraine with aura because they don’t contain estrogen. Non-hormonal options, like the copper IUD, may also be a good fit, depending on your needs and preferences.

The good news is that you still have reliable options. What matters is that you understand the connection between migraine with aura and birth control so you can make informed decisions.

What is migraine with aura?

Migraine with aura affects about 25% of people who experience migraine. Unlike a typical headache, it’s a neurological condition that comes with warning signs before the pain begins. These “auras” can include visual changes like flashing lights, zigzag lines, or blind spots. Some people may also notice tingling or numbness in their face, hands, or tongue.

One of the defining features of aura is its pattern. Symptoms usually develop gradually and last anywhere from 5 to 60 minutes before the headache phase begins. While vision changes are the most common, some people may also have trouble speaking, feel weakness on one side of the body, or experience more than one type of symptom at a time.

How hormones and migraine with aura are connected

Hormones and migraine with aura have a complicated but important relationship—and for many women, that connection shows up most clearly during their menstrual cycle. Shifts in estrogen and progesterone can sometimes trigger migraine or make them worse, which is especially important to consider when thinking about birth control options.

The role of estrogen

During a natural menstrual cycle, estrogen levels rise and fall in a predictable pattern. That sharp drop right before your period is one of the most common migraine triggers, which is why many women experience their toughest migraine at that time of the month. Some women notice their migraine symptoms improve during pregnancy, when estrogen levels stay consistently high, while others feel relief during menopause as hormone fluctuations begin to settle.

Estrogen can be both protective and problematic. For some women, steady estrogen levels help reduce migraine frequency. But synthetic estrogen (like what’s found in many birth control pills) can sometimes make migraine more frequent or severe. Everyone’s body responds differently, which is why paying attention to your own patterns is so important.

The role of progesterone

Progesterone doesn’t have as clear a link to migraine as estrogen does, but it can still play a part. Some women find that progesterone-only methods of contraception help stabilize their migraine patterns, others notice little to no change, and some also note worsening of their migraine symptoms.

Any hormonal shift, whether from your natural cycle, pregnancy, or contraceptive use, has the potential to influence migraine patterns.

Why migraine with aura needs extra care

Research suggests that women with migraine with aura may be especially sensitive to hormone changes compared to those with migraine without aura.

That sensitivity makes it extra important to choose birth control thoughtfully. Often, it takes some trial and error alongside medical guidance to find an option that feels both effective and safe for you.

Birth control and stroke risk for migraine with aura

Research also shows that people with migraine with aura who use combined hormonal contraceptives (those containing estrogen) have a higher risk of ischemic stroke compared to people without this condition.

While the overall risk of stroke is still low, studies suggest that women with migraine with aura who take estrogen-containing birth control face a higher risk compared to those without migraine with aura. That risk increases even more when combined with:

• Smoking
• High blood pressure
• Age over 35

Because of these risks, the World Health Organization classifies combined oral contraceptives as not recommended for women with migraine with aura.

Why estrogen matters for stroke risk

During a migraine with aura, changes in blood vessels affect how blood flows to the brain. Estrogen, like the synthetic kind in combined hormonal birth control, can increase blood clotting. Together, these effects raise stroke risk.

Key things to know about estrogen and migraine with aura:

• The concern isn’t just about the amount of estrogen—even low-dose estrogen pills carry risk.
• Synthetic estrogen makes blood more likely to clot.
• Most providers recommend avoiding estrogen-based contraception completely if you have migraine with aura.

What combined hormonal contraceptives should you avoid?

Combined hormonal contraceptives aren’t just pills, they also come as patches and vaginal rings. All of them contain both estrogen and progestin, which means they carry similar risks.

• Pills: taken daily, available in many formulations, but all with estrogen risk.
• Patches: worn on the skin and replaced weekly, but still deliver estrogen.
• Vaginal rings: placed in the vagina and replaced monthly, but again, estrogen is present.

While really effective for pregnancy prevention, these options are not a safe choice for people with migraine with aura.

The best birth control for migraine with aura

For people with migraine with aura, the safest birth control choices are those that don’t contain any estrogen. The good news is that there are several highly effective alternatives.

At Nurx, we typically recommend progestin-only methods, such as the mini pill, the birth control shot, or the implant, since they carry a lower stroke risk.

Why progestin-only options are safer

Progestin-only methods prevent pregnancy in ways that don’t rely on estrogen:

• They thicken cervical mucus, making it harder for sperm to reach an egg.
• They thin the uterine lining, so implantation is less likely.
• Some methods may also limit ovulation, but without the estrogen that can trigger a migraine or raise stroke risk.

Top options for migraine with aura

Here are some safe and effective methods to consider:

• Progestin-only pills (Camila®, Norethindrone): Reliable with consistent use. The traditional mini-pill needs to be taken within a 3-hour daily window.
• Hormonal IUDs: Release a small, steady amount of progestin directly into the uterus. They’re over 99% effective, last 3–7 years, and often make periods lighter or disappear.
• Birth control implant: A small rod placed in the arm that provides up to 3 years of contraception.
• Depo-SubQ Provera 104® injection: Given every 3 months, offering convenience for those who don’t want a daily or long-term method.
• Copper IUD: A completely hormone-free option, effective for up to 10 years. This can be a great choice if you want reliable birth control without any hormonal influence on your migraine.

Benefits of switching

For many women, moving from estrogen-containing pills to progestin-only methods not only lowers stroke risk but may also improve migraine patterns. Some people notice fewer or less severe migraine after switching.

Why low-dose estrogen pills aren’t recommended

You might wonder if low-dose or ultra-low-dose estrogen pills are a safer compromise. Unfortunately, even small amounts of estrogen still raise stroke risk if you have migraine with aura.

Medical guidelines consistently recommend avoiding any estrogen-containing contraceptive, especially as safer alternatives are available.

Factors to consider before choosing a hormonal contraceptive

If you experience migraine with aura, finding the right birth control is about more than simply avoiding estrogen. At Nurx, we help you weigh options like progestin-only mini pills, the birth control shot, and other alternatives—while also considering your lifestyle, health, and personal preferences.

A few things to think about as you decide:

• Daily routine: If remembering a pill at the same time every day feels stressful, long-acting methods like IUDs or the implant may be a better fit.
• Future pregnancy plans: Some methods allow fertility to return quickly once they’re removed (like IUDs and implants), while others (like the Depo-Provera® shot) may delay fertility for several months.
• Migraine patterns: Tracking when your migraine happens in relation to your cycle when on birth control can help guide which method might work best for you. Some progestin-only methods stabilize migraine patterns, while others may not make much difference.
• Side effects: Progestin-only options avoid estrogen’s stroke risks, but they can come with temporary irregular bleeding, mood changes, or weight shifts for some women.

Multiple risk factors and cardiovascular health

If you have other risk factors for heart or vascular disease, like smoking, high blood pressure, diabetes, or a family history of stroke, your contraceptive choice becomes even more important.

Women over 35 with migraine with aura already face a higher baseline stroke risk, which makes estrogen-containing methods especially unsafe.

Talking to a healthcare provider about your migraine

Talking openly with your healthcare provider about birth control is always an important step. The more information you share, the better they can help you find a method that’s safe, effective, and fits your life.

Here are a few ways to prepare for that conversation:

• Share your migraine history: Note how often your migraine happens, what tends to trigger them, and what your aura symptoms look like. This gives your provider a clearer picture of how hormones may play a role.
• Talk about your overall health: Be upfront about any medications you take, whether you smoke, your family history of stroke or heart disease, and your past experiences with birth control. These details help your provider guide you toward the safest choices.
• Ask questions: Don’t hesitate to ask how different methods might affect your migraine, your cycle, or your general health. A good provider will walk you through both the benefits and potential side effects.
• Discuss what matters most to you: For some people, pregnancy prevention is the top priority. For others, convenience, side effects, or reversibility matter just as much. Your provider can help balance these needs.

Finding the right fit can sometimes take a little trial and adjustment—and that’s completely normal. What matters most is that you feel supported and confident in your care plan.

Safely navigating migraine with aura and birth control

Managing migraine with aura while choosing your birth control does need some thoughtful consideration, but you don’t need to let it stress you out. There are safe and effective options you can choose from.

The most important thing is avoiding estrogen-containing methods that can increase your stroke risk, while exploring alternatives that still meet your contraceptive needs. Whether you choose a hormonal IUD, progestin-only pills, the implant, or a non-hormonal option like the copper IUD, you can still prevent pregnancy without compromising your health.

With the right guidance and tools—like those available through Nurx—you can confidently manage both your contraceptive needs and migraine concerns, making choices that support your health, lifestyle, and peace of mind. Start your birth control journey today. 

We can also assist with your migraine headaches—feel free to reach out and connect with our partner Cove for migraine management and treatment.

Frequently Asked Questions (FAQ):

Can I take birth control if I get migraine with aura?

If you experience migraine with aura, estrogen-containing birth control is not recommended due to increased stroke risk. Nurx offers progestin-only options like mini pills, which are considered safer alternatives.

How to prevent hormonal migraine with aura?

Hormonal migraine often follows patterns related to your menstrual cycle. Managing hormone fluctuations can help reduce migraine frequency. Estrogen-free birth control options are usually a helpful route to take here. 

Does high estrogen cause migraine with aura?

Yes, in some people, higher estrogen levels can trigger migraine with aura. Monitoring how your hormones affect your migraine is important.

The information provided is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon this content for medical advice. If you have any questions or concerns, please talk to a medical professional.

Services not offered in every state. Medications prescribed only if clinically appropriate, based on completion of required consultation. Individual results may vary.

Camila® (norethindrone 0.35mg, oral tablets, USP), Rx only, is an oral contraceptive used to prevent pregnancy. This drug may cause side effects, including irregular and/or heavy uterine bleeding, headache, breast tenderness, nausea, and dizziness. If you would like to learn more, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Norethindrone (progestin-only tablets, USP .35mg), Rx only, is an oral contraceptive used to prevent pregnancy. Norethindrone may cause side effects, including nausea, headache, breast tenderness, irregular bleeding, and missed period. If you would like to learn more about norethindrone, please see the full prescription information here.

Depo-SubQ Provera 104® (medroxyprogesterone acetate injectable suspension, 104mg/0.65mL for subcutaneous use), Rx only, is used as contraception to prevent pregnancy. This drug may cause side effects, including dysfunctional uterine bleeding (irregular, increase, decrease, spotting), headache, and weight gain. Meningiomas have been reported after repeated administration of medroxyprogesterone acetate, primarily with long-term use. Patients using this form of birth control should be monitored for signs and symptoms of meningioma, and treatment should be discontinued if a meningioma is diagnosed. If you would like to learn more, see full prescribing information, here. You are encouraged to report negative side effects to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Not all options discussed in the blog are available through Nurx. Please see Nurx.com for details.

None of the following medications are offered by Nurx: Mirena®, Kyleena®, Skyla®, Nexplanon®, or Paragard®. You can learn more about each drug including  risks and side effects at www.mirena-us.com, www.kyleena-us.com, www.skyla-us.com, www.nexplanon.com, and www.paragard.com, respectively. All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx.