Is my Mirena IUD making my migraines worse at 31?

Question

Hello doctor,

My migraine headaches began during puberty, but became disabling after I had the Mirena intrauterine device (IUD) inserted about two years ago. The attacks now occur three to four times a week and are characterized by severe throbbing pain that causes vomiting and forces me to stay in a dark room for several days.

I take Rizatriptan 10 milligrams (a triptan-class medication), but it only helps if I take it at the very early stage of the headache. My neurologist has tried several preventive medications, including Propranolol (a beta-blocker) and Amitriptyline (a tricyclic antidepressant), but either they do not work or they cause intolerable side effects.

The migraines always become worse right before my period, even though the Mirena IUD has made my menstrual cycles lighter. I experience visual disturbances, such as zigzag lines, about 30 minutes before each attack, which helps me prepare.

Bright lights at work trigger the episodes immediately, so I have to wear special glasses indoors. I also tried elimination diets by removing cheese, chocolate, and wine, but there was no noticeable improvement.

The chronic pain has severely impacted my job performance, and I have already used up all my sick leave for the year. My hormone levels showed Estradiol at 45 picograms per milliliter, which is considered low for my age of 31 years.

My visits to the emergency room have increased because triptans are no longer effective during severe attacks. Botox (OnabotulinumtoxinA) injections helped for about three months, but my insurance requires me to try more oral medications before continuing with Botox.

Should I consider removing the Mirena IUD to see if hormonal changes are triggering my migraine headaches?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

According to your medical history and your concern regarding migraine, Mirena is a Levonorgestrel-containing intrauterine contraceptive device (IUCD). Mirena provides long-term birth control for up to eight years. It may be used whether or not you have children.

Mirena is also approved for use for up to five years to treat heavy menstrual bleeding in females who choose an intrauterine method of birth control. The Mirena IUCD releases Levonorgestrel (a progestin hormone) into the uterus, but only a small amount of the hormone reaches the bloodstream.

Mirena may produce certain side effects in the body, which are as follows:

Alterations in menstrual bleeding patterns.
Abdominal and pelvic pain.
Amenorrhea (absence of menstruation).
Headache or migraine.
Genital discharge.
Vulvovaginitis.

As you mentioned, you have already tried several methods to get relief from migraines, but none seem to work effectively. This is likely because your migraines may be a side effect of the Mirena IUCD.

You are advised to consider the removal of Mirena and opt for alternative contraceptive methods such as injectables or implants, which have similar effectiveness and often fewer side effects.

Please feel free to raise a follow-up query if you have any additional health concerns.

I hope this helps.

Thank you.