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Topamax for migraines, ParaGard caused long periods; now considering Mirena IUD or the NuvaRing. Please help! #143/10
I am a migraine sufferer currently on 200mg of Topamax/day. To reduce the occurance of my migraines, I got the Paragard IUD. I am experiencing extremely long periods, however (up to 6 weeks). My doctor's only response is to put me on hormones (progesterone) to stop the bleeding but it instantly gives me a migraine.

I am considering switching to the Mirena IUD, but am nervous about having ANY hormones in my body.  Will the hormones in Mirena cause migraines? Do you think the Paragard is causing the long bleeding?

Any advice would be appreciated because right now my doctor just wants to put me on the NuvaRing, which doesn't seem like a good idea for my migraines.

1.     I am sorry that you are having problems both with migraine headaches and with your ParaGard IUD. ParaGard is most likely causing your long periods.

2.     I won't say it could never happen, but Mirena IUDs are not associated with an increased risk for migraine headaches and could possibly even help by remarkable decreasing menstrual bleeding and menstrual cramps and pain.

  1. If you were to go on the NuvaRing, I would suggest that you use it continuously; leaving it in for a month at a time (it actually stops ovulation for up to 35 days).  This definitely could diminish your migraine headaches and could easily be discontinued if so desired.
  2. VERY IMPORTANT:  Do you have aura before your migraine headaches?  See below:


In 1988 the International Headache Society published their first diagnostic criteria for the diagnosis of migraine with and without aura.  These guidelines were further revised in the 2nd edition in 2003.


2nd Edition International Headache Society Classifications

Migraine without Aura

Typical Aura with Migraine Headache

A)    At least 5 attacks fulfilling criteria B-D

B)     Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)

C)    Headache has at least 2 of the following characteristics

1)      unilateral location

2)      pulsating quality

3)      moderate or severe pain intensity

4)      aggravation by causing avoidance of routine physical activity (e.g., walking or climbing stairs)

D)    During headache at least 1 of the following:

1)      nausea and/or vomiting

2)      photophobia and phonophobia

      E)  Not attributed to another disorder





A)    At least 2 attacks fulfilling criteria B-D

B)     Aura consisting of at least one of the following, but no motor weakness:

1)      fully reversible visual symptoms including positive features (e.g., flickering lights, spots, or lines) and/or negative features (i.e., loss of vision)

2)      fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness)

3)      fully reversible dysphasic speech disturbance

C)    At least 2 of the following:

1)      homonymous visual symptoms and/or unilateral sensory symptoms

2)      at least one aura symptom develops gradually over >= 5 minutes and/or different symptoms occur in succession over >= 5 minutes

3)      each symptom lasts >= 5 and  <= 60 minutes

D)    Headache fulfilling criteria B-D for Migraine without Aura begins during the aura or follows aura within 60 minutes

E)     Not attributed to another disorder



The most common aura feature is visual, and there are several types that are common among people who get migraines.


The following 3 examples are from Dr. Todd Troust’s website: http://imigraine.net  

 Successive arcs expand across half of visual field, as shown in two diagrams based on Airy. The spectra may take 20 to 25 minutes to expand from a fuzzy gray area near the fixation point (dot) to the outer limit of the visual field. (Richards W: The fortification illusions of migraines. Sci Am 224:88, 1971)



Emerging honeycomb pattern form plotting data derived from visual phenomena in migraine subjects. Honeycomb and tendency for inner angle between lines to approximate 60 suggests a hexagonal organization of occipital cortical cells. (Richards W: The fortification illusions of migraine. Sci Am 224:88, 1971)

Scintillating Scomata (above)


These visual disturbances can be very frightening, and extremely intense.  Some say they have the intensity of a flickering fluorescent light bulb.

Aura vs. Prodrome

Although a prodrome, like an aura, begins before the migraine, they are not the same.  Some people feel “strange” a day or so before a migraine attack.  This strange feeling, or prodrome, are the first signs of an attack and can include yawning, mood change, food cravings, excitability, or tiredness.

(Migraine Action Association Homepage (UK))


Here are the World Health Organization’s conclusions about use of hormonal contraceptives by women with headaches:


LOW-DOSE CONBINED ORAL CONTRACEPTIVES  (COCs) < 35 µg of ethinylestradiol






HEADACHES*                           1          C

a) Non-migrainous                      1          2          Clarification: Classification depends on

    (mild or severe)                                              accurate diagnosis of those severe head-

                                                                        Aches that are migrainous and those that

                                                                        are not.  Any new headaches or marked

                                                                        changes in headaches should be evaluated.

                                                                        Classification is for women without any other

                                                                        risk factors for stroke.  Risk of stroke increases

                                                                        with age, hypertension and smoking.


b) Migraine                                                        Evidence: Among women with migraine,

                                                                        women who also had aura had a higher risk

    (i) without aura                                               of stroke than those without aura.  Among

            Age < 35                       2          3          women with migraine, those who used COCs

            Age > 35                       3          4          had a 2 to 4-fold increased risk of stroke

                                                                        Compared with women who did not use COCs.

    (ii) with aura, at any age         4          4                                                                     




International Headache Society.  2nd edition International Headache Society Classifications.  Available from http://www.i-h-s.org.  [Accessed 12 October 2004]


MacGregor, Anne. Migraine, Aura & Combined Oral Contraceptives.  Association of Reproductive Health Professionals Meeting.  10 September 2004.


Migraine Action Association.  What is a Migraine?  Available from http://www.migraine.org.uk/whatis.htm.  [Accessed 9 October 2004]


Troost, Todd.  Migraine with Aura.  Available from http://imigraine.net.  [Accessed 9 October 2004]


Please keep me posted and I do wish you the very best!


Key words:  migraine headaches, Topamax, reduce occurrence, ParaGard IUD, long periods, hormones, progesterone, bleeding, Mirena IUD, NuvaRing, increased risk, cramps, pain, continuously 

Posted 2-22-2010, Updated 3-4-2010, Updated 3-13-2010, Updated 3-21-2010


Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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