Full Question:

I started getting migraines shortly after the birth of my son who is now 21 years old.  I have been diagnosed with menstrual migraines and use the triptans (Amerge, Frova, Imitrex, Relpax) to treat them. Amerge for some reason works best for me.

I also get migraines with major weather changes or stress. I have tried many preventives (nortriptyline, amitriptyline, gapabentin, Topamax, Neurontin) with no elimination of the migraines. 

Since my son was born I have been on birth control pills (Joliette, Ortho Novum, Necon, Yaz).  I am wondering if the birth controls could be causing the majority of my migraines?  Is there another preventative that I could try that would work better or should I discontinue the birth control pill? Any suggestions would be helpful. Thank you! Larissa.

Answer:

Dear Larissa;

Oh, my dear, but you know how to ask the difficult questions!

Hormonal triggers are quite difficult to figure out and manage. Just the fluctuation of hormones during your cycle can present a very strong trigger, thus your menstrually triggered Migraines. Hormonal birth control can make things worse or better, or make no difference at all. The only accurate way to know if the birth control pills are a culprit in triggering your Migraines is to stop them for a few months and track your Migraines to see if it makes a difference. You can download a free diary workbook from our article Your Migraine and Headache Diary. The birth control pills could be making your Migraines worse, or it could be hormonal changes from the birth of your son.

You say the preventive medications you tried didn't eliminate your Migraines. Did any of them decrease the number or severity of them at all? It's rare for any preventive to totally eliminate Migraines, regardless of the trigger. If a preventive medication helps, it's common to increase the dosage, if possible, or to add another medication if the dosage of the first can't be increased. If increasing the original preventive doesn't help, taking it back down to the lowest effective dosage and adding a second medication is a common practice. There are many options here since There are now over 100 medications and supplements that can be used for Migraine and headache prevention. The frustration of trying to find what works for us can make it seem as if we’ve tried it all, but with so many possible preventives, it’s literally impossible to have tried them all. See Migraine preventive medications – too many options to give up! for more information.

Let's at least touch on the subject of stress as a trigger too. There's still some controversy, but we hate to see anyone accept that stress is a trigger without at least trying to see if they encounter triggers during stressful times that they either don't encounter at other times or they're only triggers when the body is stressed. The International Headache Society has removed stress from their list of Migraine triggers and put it on their list of exacerbating factors -- things that make us more susceptible to our triggers. Many people have sworn stress was a trigger for them until they kept a very detailed diary for a few months. More information in Is Stress a Migraine Trigger?. We hope you'll thoroughly investigate this as we think we do ourselves a real disservice by thinking stress is a trigger for us and not looking closely for other triggers during stressful times.