Migraine with aura and combined pill

[Yadda]

I have migraine with aura (and numbness and slurred speech), but I've gone from having 5 or 6 a year, to only having one in the last five years on a very hot day when I was about 7 months pregnant.

My gynaecologist wants to prescribe me the combined pill to regulate my cycles. I've told her all of the above and whilst she agrees that it's contraindicated for use with migraine with aura she also takes it. I'm concerned about the stroke risk.

My question is does anyone who experiences migraine with aura also take the combined pill?

I did and had done for years but my current GP took me off it when I was going through a rough patch of migraine and headaches and won’t prescribe it for me again which is per the guidelines I believe.

I did and every packet break I had a migraine. I could set my watch by it. The doctors solution was to not have a break. I took three packets back to back and the hormones completely messed with my body. I'm off it now and while I still get hormone related migraines they're not as bad.

I had to stop taking it because of severe migraines, like you I had slurred speech and numbness.

I have had a mirena coil for the past 9 years and have barely had a migraine since.

Your gynaecologist is brave. Migraine with aura is a complete contraindication for COCP. It comes in the "Do not prescribe" category from the faculty of sexual and reproductive health. I'm a GP and I would refuse to issue this for you if you had migraine with aura on your records.

Agree with above poster
I'm a practice nurse and do the contraception starts and checks.
Absolute no no for combined pill if lady is a migraine sufferer
Try progesterone only pill/implant/injection/coil?

Yes, I agree with the posters. I've moved around a bit and every GP I've seen has said no to the pill. This is why I find the gynae approach so bizarre. The only area if reluctance from her pov is my weight (BMI 27). She reluctantly conceded that when I pointed out that GPs had been saying no to the pill for contraception since I was 19 with a BMI of 20.

However, we concluded with her maintaining she'd be happy to prescribe if my BMI dropped to 25 or below. Still won't solve the contraindications of migraine with aura.

My GP looked horrified when she realised that I was still taking the combined pill 😬

Google the NICE guidelines and see what you think. The recommendation is based on two studies, both of which are pretty poor evidence of a link between migraine with aura and increased risk of stroke with oestrogen, but concludes that it shouldn't be prescribed just in case, since there are plenty of alternative contraceptive options. (Unless there's more evidence since I looked it up a few years ago!).

No no no no no! Ffs. Massive contraindication. No doctor or nurse in their right mind (or values their professional qualifications) would prescribe this. If you were in my clinic you would NEVER be prescribed this ever again.

Do NOT take the combined pill under any circumstances with this type of migraine!!!

I am a family planning nurse. With your history I would not even consider placing you on a combined pill or any other oestrogen containing methods. The risk of stroke and blood clot far outweigh the benefits of taking this method.

I was taken off the combined pill by an absolutely horrified gynae who told me it was an absolute contraindication for anyone with focal migraines.

There are links with cardiovascular events. Migraine with aura in itself is associated with an increased risk of ischaemic stroke. Oestrogen seems to also be associated with risk - various studies give different results but 2-14x the risk depending on the study.

Progesterone only contraceptives are not associated with increased risk.

FWIW, my incidence of migraine dropped hugely once I was off the combined pill.