Identifying Migraine Headaches

For women who want a hormonal method , § or are using one.

If a woman reports having very bad headaches, ask her these questions to tell the difference between a migraine headache and an ordinary headache. If she answers “yes” to any 2 of these questions, she probably suffers from migraine headaches. Continue to Identifying Migraine Auras, below.

1.      Do your headaches make you feel sick to your stomach?
2.     When you have a headache, do light and noise bother you a lot more than when you do not have a headache?
3.     Do you have headaches that stop you from working or carrying out your usual activities for one day or more?


Identifying Migraine Auras

Ask this question to identify the most common migraine aura. If a woman answers “yes,” she probably suffers from migraine auras.

1.    Have you ever had a bright light in your eyes lasting 5 to 60 minutes, loss of clear vision usually to one side, and then a headache? (Women with such aura often bring one hand up beside their heads when describing the vision change. In some cases the bright light is not followed by a headache.)

If her headaches are not migraines and she does not have aura, she can start or continue hormonal methods if she is otherwise medically eligible.  Any later changes in her headaches should be evaluated, however.

Can a Woman With Migraines and/or Aura Use
a Hormonal Method?

In situations where clinical judgment is limited: Yes = Yes, can use    No  = No, do not use
 I  = Initiation    C  = Continuation
  Combined methods Progestin-only methods§
Migraine headaches I C I C
Without aura  
    Age < 35 Yes No Yes Yes
    Age ≥ 35 No No Yes Yes
With aura, at any age No No Yes No

Methods with estrogen and progestin: combined oral contraceptives, monthly injectables, combined patch, and combined vaginal ring

§Methods with progestin only: progestin-only pills, progestin-only injectables, and implants