Migraine with Aura Risk Calculator
Calculate Your Stroke Risk
This tool estimates your stroke risk based on migraine frequency and other key factors. Results are approximate and should not replace medical advice.
If you get migraines with aura - the flashing lights, blind spots, or tingling that come before the headache - and you’re thinking about birth control, you’re not alone. But you’re also facing a decision that could affect your long-term health. For years, doctors have told women with migraine with aura to avoid birth control pills that contain estrogen. The reason? A higher risk of stroke. But now, new research is shaking up that advice. Is it still true? Should you avoid estrogen entirely? Or could a low-dose pill be safe for you? Let’s cut through the noise and give you clear, practical answers based on today’s science.
What Exactly Is Migraine with Aura?
Migraine with aura isn’t just a bad headache. It’s a neurological event. Before the pain hits, you might see zigzag lines, blind spots, or bright flashing lights. Some people feel numbness in their hand or face, or have trouble speaking. These symptoms usually last 5 to 60 minutes and fade before the headache starts. If you’ve had this, you have migraine with aura.
It’s important to know what doesn’t count as aura. Nausea, sensitivity to light, fatigue, or mood changes? Those are warning signs - not aura. Aura means actual neurological disruption. If you’re unsure, track your symptoms. Write down what happens before your headache. Did you lose vision? Did your hand go numb? If yes, you have aura. If not, you likely have migraine without aura - and your risk profile is very different.
Why Estrogen Birth Control Is a Concern
Estrogen in birth control pills makes your blood more likely to clot. For most women, that’s fine. But if you have migraine with aura, your brain is already more sensitive to changes in blood flow. Combine that with estrogen, and your stroke risk goes up.
Here’s the hard number: Healthy young women without migraines have about a 6 in 100,000 chance of having an ischemic stroke each year. For women with migraine with aura who take estrogen-containing birth control, that number jumps to about 30 in 100,000. That’s a fivefold increase. The CDC says the combined risk - having migraine with aura and using estrogen birth control - is six times higher than having neither.
The World Health Organization (WHO) has been clear since 2015: Women with migraine with aura should not use estrogen-containing contraceptives. That’s a Category 4 - meaning the risks outweigh any benefits. The CDC and American College of Obstetricians and Gynecologists (ACOG) agree. This isn’t a suggestion. It’s a hard recommendation.
But New Research Says It Might Be Different
Here’s where things get messy. A 2022 study led by Dr. Pinar Batur at the American Migraine Foundation looked at modern, low-dose birth control pills - the kind with 20 to 35 micrograms of estrogen, not the old high-dose versions from the 1970s.
Their findings? The stroke risk might not be as high as we thought - especially with pills under 30 micrograms of ethinyl estradiol. Some women even reported fewer auras while on ultra-low-dose pills (10-15 micrograms). Dr. Anne Calhoun from Stanford Medicine argues that the fear around estrogen and stroke is based on outdated, high-dose pills. Today’s pills are much safer.
But here’s the catch: Dr. Batur’s study only included 127 women who had strokes. That’s a tiny group. The study wasn’t large enough to give a definitive answer. She herself says, “This is only one piece of the puzzle.”
Meanwhile, the WHO and CDC haven’t changed their guidelines. Why? Because the evidence isn’t strong enough yet. We need bigger, long-term studies tracking thousands of women on low-dose pills over years. Until then, the official stance remains: avoid estrogen if you have aura.
How Often Do You Get Migraines? It Matters
Not all migraine with aura is the same. Frequency plays a huge role in stroke risk.
- If you have aura more than 12 times a year, your stroke risk jumps dramatically - up to 10 times higher than women with no migraines.
- Even monthly attacks carry some risk, but the biggest danger is when you have aura weekly or more.
- Interestingly, women who have aura less than once a month also show a small increase in risk - not as high, but still there.
And here’s something critical: If you haven’t had an aura in over a year, your risk drops back to near baseline. That means if your migraines have calmed down, you might be safer than you think. But if you’ve had an aura in the last 12 months, you’re still in the high-risk group.
What About Other Risk Factors?
Estrogen and migraine with aura aren’t the only players. Smoking? That’s a big one. If you smoke and have aura, your stroke risk multiplies. High blood pressure? Same thing. Diabetes? Family history of stroke? All of these stack on top of your baseline risk.
That’s why doctors don’t just look at your migraine history. They look at your whole picture. A 32-year-old non-smoker with high blood pressure and migraine with aura is at higher risk than a 28-year-old non-smoker with normal blood pressure and occasional auras.
If you smoke, quitting is the single best thing you can do - not just for birth control safety, but for your long-term health. No pill, no matter how low-dose, is safe if you smoke and have aura.
What Are Your Safe Alternatives?
You don’t have to go without birth control. There are plenty of safe, effective options that don’t contain estrogen.
- Progestin-only pills (mini-pill): Taken daily. No estrogen. Lower risk of stroke.
- Levonorgestrel IUD: Lasts 3 to 8 years. Releases progestin locally. Almost no systemic hormones.
- Etonogestrel implant: Small rod under the skin. Lasts 3 years. Very effective.
- Depo-Provera shot: Given every 3 months. Progestin only.
- Copper IUD: No hormones at all. Works for up to 12 years.
- Barrier methods: Condoms, diaphragms - less effective on their own, but safe.
These methods don’t raise your stroke risk. In fact, the American Migraine Foundation and ACOG specifically recommend them for women with migraine with aura. Many women find that progestin-only methods even help reduce migraine frequency over time.
What Should You Do Right Now?
Don’t panic. Don’t stop your pill cold turkey. But do take action.
- Track your migraines. For the next 3 months, write down every aura episode. How often? What symptoms? How long do they last?
- Check your health. Get your blood pressure checked. If you smoke, make a quit plan. Ask your doctor about your cholesterol and family history.
- Ask your provider: “Based on my migraine pattern and other risk factors, is estrogen birth control safe for me?” Don’t let them brush you off. Bring this article. Print the WHO guidelines. Be prepared.
- Consider switching. If you’re on a pill with 30+ micrograms of estrogen, ask about switching to a lower dose - or better yet, switch to a progestin-only option.
If you’re on a low-dose pill (20-25 micrograms) and feel fine, don’t assume it’s safe just because you feel okay. The risk is still there - even if it’s smaller. Your brain doesn’t feel the clot forming before it’s too late.
The Bottom Line
The safest choice for women with migraine with aura is still a non-estrogen contraceptive. Progestin-only methods are reliable, effective, and don’t raise your stroke risk. Modern low-dose estrogen pills might be safer than the ones from 20 years ago, but we don’t have enough long-term data to say they’re safe for everyone.
If you’re young, healthy, don’t smoke, and have infrequent auras, you might be tempted to try a low-dose pill. But the risk, even if small, is real. And stroke doesn’t care if you’re healthy - it strikes without warning.
For now, the best advice is still: avoid estrogen if you have aura. But if you’re already on it and want to stay on it, talk to your doctor. Get your numbers. Make an informed choice. Your future self will thank you.
