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complex migranes and the pill


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hi

i just saw my gyno today and she saw on my chart that i had migranes.  she asked me a few questions, and said that my migranes sound like "complex migranes" (for me, i loose parts of my vision, but there are other things that make a migrane a "complex migrane"... )

anyway, she said that women with complex migranes on estrogen birth control have a much higher risk of stroke than women w/o complex migranes and that she, and many other doctors, no longer rx estrogen birth control to women with complex migranes because of this. 

she's sending me off for further eval to make sure that my migranes are indeed "complex" and if they are she's going to give me the mirena iud.  other prgesterone only methods of bc are the "mini pill" (progesterone only pill) and the deprovera shot.

anyway.  i'd NEVER heard this (and she was like, i know, i know, you've been on the pill for years and had migranes for years and no one has mentioned this... but this is what we now do here.)

so... i thought i'd give you ladies a heads up on this.

penny

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Thanks, Penny. It's interesting because I think BCPs are what made me start getting migraines in the first place. It could be just a coincidence, but I had never had a migraine in my life until I went on BCPs. I was only on them for a few months, but the migraines continued. So probably just a coincidence.

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Thanks Penny.  That is interesting.  My migraines didn't start until after a head injury involving a car accident.  Before that I rarely even had headaches, unless I drank too much. 

I've had endometriosis since I was 14 and have been on birth control continuously to stop my periods since then.  I never had migraines that were associated with my cycles.  I can't imagine going off birth control and enduring the the painful cramps, heaving 2 week bleeding, etc...that coming with my endo. 

I haven't read anything regarding a higher incidence of strokes in complex migraine patients either and I'd like to know why that is.  Incidence of stroke in BC users has gone done considerably since BC first came out because the amount of estrogen is so much less in the pills now days. 

In my case, I'll take the risk, because my endo is completely unmanageable without BC pills.

Thanks again for sharing Penny!

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Sunshine,

bc pills can trigger migranes and headaches in general.  as for them sticking around after you went off the pill, no idea.

dumbfox,

i get the feeling my doctor is being very cautious... but it does seem like migranes with aura are associated with a higher risk of stroke than migranes without aura.  everything has risks, and for you it makes sense to take that risk as otherwise you'd be in incredible pain.  it's true that the risk of stroke has gone down a lot with the new low dose pills, but i guess because of how complex migranes work neurologically, there's just more of a risk?  seeing as i only found out yesterday that all migranes don't have auras, i'm a bit confused and i can't find a "why".... but here's a little quote from an article about it. 

Oral contraceptives in women with migraine: balancing risks and benefits.

In any case, while an increase in migraine frequency or intensity do not oblige the cessation of OCs, experiencing a migraine aura for the first time, or even a clear worsening of a preexistent aura suggest discontinuation of OCs. Even if both migraine and OCs intake are associated with an increased risk of ischaemic stroke, migraine per se is not a contraindication for OCs use; however, patients suffering from migraine with aura generally show a greater thrombotic risk than women with migraine without aura.... A thorough laboratory control of the genetics of prothrombotic factors and coagulative parameters should precede any decision of OCs prescription in migraine patients.

also, according to american heart association:

Migraine-sparked vision loss may increase stroke risk in women; migraine may be risk factor for stroke in young adults

Women who experience vision loss as a symptom of migraine have a 70 percent increase in risk of stroke compared to women who don

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Huh?! No, that just confuses me more.  LOL 

It's still interesting and I'm going to try and read up more on it.  I wonder if it's got to do with ocular pressure? And now I'm wondering if my being on Topamax will increase my risk of stroke?  I'm thinking too hard.  I do get auras, multiple in fact, which my doctor says is rare, which I don't know whether to buy or not.  I get color disturbances (this odd bluish tint to everything) and star-bursts.  I also get scent and auditory disturbances. 

Thanks for the posting the links!

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Huh?! No, that just confuses me more.  LOL 

It's still interesting and I'm going to try and read up more on it.  I wonder if it's got to do with ocular pressure? And now I'm wondering if my being on Topamax will increase my risk of stroke?  I'm thinking too hard.  I do get auras, multiple in fact, which my doctor says is rare, which I don't know whether to buy or not.  I get color disturbances (this odd bluish tint to everything) and star-bursts.  I also get scent and auditory disturbances. 

Thanks for the posting the links!

what do you mean multiple auras?

the american heart said it was mostly w/ women who loose vision... like um, i get like half of what is there i can't see and it's just black, like a slash and the top half is gone, or like a big black hole?

i'd think that having your seizures controlled with topamax would reduce not increase your risk. 

i'm still trying to figure out how a migraine causes a stroke.  migraines are when blood vessels expand.  so... how does that cause a stroke?  i'd think it would cause aneurysms?  and i don't know if the visual is pinching a nerve... i think it's a neurological thing.

your doc... you are seeing a neuro? oh wait, i read your response to the daily migrane thing.  nice docs are hard to find.  nice neuros are a myth.  have you had a differential dx for temporal lobe seizures?  (i'm not trying to scare you, and from what i've read you've been through the health care ringer)  you can hallucinate smells w/ migranes, but it's also a sign of TLE so i was just wondering if they checked for that is all.

sorry i confused you more.  i'm also confused.  maybe in like a month we'll figure this out...

penny

edited for spelling and also to add an apology for no sense making, my body decided to wake up at 3 am and my brain is still really pissed off about this.

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I've been suffering from migraines since about age 12.  It wasn't until a year ago that I started getting multiple migraines a week (2-4/week).  The first thing that we (my gyn and I) talked about was my BC.  I was and am still on NuvaRing.  She determined that it wasn't the ring and moved on to trying to find something that would work.  1 year later, 2 neuros and several meds - I am still having them.  Now I wonder if is isn't the ring?  That would be terrible because I LOVE NUVARING!

When I first started to have them so frequently, the first thing that came to mind was BC since I had read that it could cause migraines.

-Jen

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what do you mean multiple auras?

the american heart said it was mostly w/ women who loose vision... like um, i get like half of what is there i can't see and it's just black, like a slash and the top half is gone, or like a big black hole?

i'd think that having your seizures controlled with topamax would reduce not increase your risk.

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Heya,

Nobody knows really WTF migraines are.  That's the big secret.

And it's been observed that risk of clots increases in women on estrogen, if they have migraine with multiple-aura.

And we don't know why.

So, we don't Rx estrogen as a rule to women with migraine-plus-multi-aura.

Playing it safe.

--ncc--

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Heya,

Nobody knows really WTF migraines are.  That's the big secret.

And it's been observed that risk of clots increases in women on estrogen, if they have migraine with multiple-aura.

And we don't know why.

So, we don't Rx estrogen as a rule to women with migraine-plus-multi-aura.

Playing it safe.

--ncc--

so... how is it that i've been on bc w/ multi aura migranes for um 10 years and no doc has said this?  wtf!

anyway, tomorrow i talk to someone about blah blah and then i gues mirena iud time. i'm both scared and excited about getting the mirena iud. 

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