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Birth control if you smoke or get migraine

Editorially reviewed on October 29, 2026. [TODO: medical reviewer]

Quick answer

If you smoke and are 35 or older, or you get migraine with aura (flashing lights or zigzags before a headache), combined pills with estrogen are generally not safe for you because of the higher risk of stroke and blood clots. Progestin-only pills, the implant, the injectable, IUDs and condoms are options. Tell your doctor about smoking and headaches before getting any prescription.

Why estrogen is the issue

Estrogen in combined pills slightly raises the risk of blood clots and stroke. Smoking and migraine with aura each raise that risk too, so together the risk becomes too high ^[src]. WHO's medical eligibility criteria rate combined methods as unsuitable in these situations and allow progestin-only and non-hormonal methods ^[src].

Options to discuss

Progestin-only pill: Daphne (lynestrenol), Exluton (lynestrenol) or Cerazette (desogestrel).
Implant or injectable: progestin only.
IUD: copper (no hormones) or hormonal.
Condoms: no hormones and STI protection.

Migraine without aura?

Migraine without aura is a different situation, and a doctor may still consider a combined pill depending on your age and other risks ^[src]. If your headaches change, become more frequent, or you develop aura after starting a pill, stop and see a doctor.

Under 35 and smoke?

Combined pills may still be possible, but tell your doctor how much you smoke. Quitting lowers your risk on any method.

Go to the ER now if you have

A sudden severe headache unlike your usual ones, weakness or numbness on one side, trouble speaking, vision loss, chest pain or a painful swollen leg.

These are method families to discuss with a doctor, not a prescription. A health center visit is free, and online consults start from ₱700 on some platforms.

Three legal routes

Get a prescription or a clinic visit

Tell the doctor about smoking and migraine. Progestin-only pills need a prescription, or are free at health centers. Pick the route that suits you. For adults 18 and over.

Free at a health center

Barangay health centers, RHUs, DOH hospitals and Likhaan. Subject to supply.

See an OB-GYN in person

Clinic visit, prescription in hand. Bring it to any licensed pharmacy.

Online consult

A licensed doctor by video or chat. From ₱700 on some platforms.

Online consult options

HatiMarketplace of clinics plus online pharmacy (MedsGo). Book a doctor, IUD or implant. Delivery listed for Metro Manila.Fee shown when you bookBook a consult KindredWomen's clinic in BGC with nationwide OB-GYN teleconsult.Fee shown when you bookBook a consult Eluvo HealthWomen's clinics and teleconsult. Implant, copper IUD and DMPA.Consult from ₱1,500Book a consult NowServingBook an OB-GYN teleconsult. Fees vary by doctor.Consult from ₱700Book a consult

For adults 18 and over. Fees are set by each provider and can change.

Frequently asked questions

Puwede ba mag-pills ang naninigarilyo?

Kung 35 pataas at naninigarilyo, hindi karaniwang inirerekomenda ang combined pills. Puwede ang progestin-only pill, implant, turok, IUD o condom. Sabihin sa doktor kung naninigarilyo ka.

What is migraine with aura?

Aura means warning signs before or during a headache, such as flashing lights, zigzag lines, blind spots, or tingling. If you get these, tell your doctor before taking a combined pill.

Does vaping count as smoking for the pill?

Ask your doctor. Tell them about any nicotine use, including vapes.

This guide is for information. Talk to a doctor before starting, stopping or switching birth control.

Sources

Combined pill: who can and cannot take it, NHS
Medical eligibility criteria for contraceptive use, World Health Organization
Combined pill: risks and side effects, NHS