Migraine plus meds (birth control pills, to be specific)

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You probably aren’t surprised to hear that patients mention headaches to me quite often. Several months ago, after a long and in depth discussion of birth control options with a patient who suffers from migraine headaches, I promised her a blog entry about the topic.  She was taking normal birth control pills (that contains both estrogen and progesterone, which we refer to as combined oral contraceptives, and I’ll just call “the pill” for the next of this post).  She suffered from migraines with aura and I told her to immediately stop her birth control pill and that she was never allowed to take them again because her risk of stroke was too high. In her years of taking the pill and having migraines with aura no one had ever counseled her like this. She was surprised. And disappointed. She had to stop her beloved pills?  She needed more convincing. This is what I told her: Continue reading “Migraine plus meds (birth control pills, to be specific)”

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Halloween is not the only time for masks

Have you heard the “mask of pregnancy?” Unfortunately this mask is one that can’t be easily removed.

The medical term for “mask of pregnancy” is melasma. It is increased pigmentation in areas of the face. Three main problem areas have been identified (we’ll use Marilyn to illustrate):

  • Centrofacial: involves forehead, cheeks, nose, upper lip, chin

  • Malar: involves the cheeks and nose

  • Mandibular: involves the sides of your jaw bone.

Melasma (any type) can occur in up to 75% of pregnant women. But this mask is not limited to pregnancy – it can occur when taking birth control pills too, or with general sun exposure, or when taking seizure medication, or with medical problems like lupus or thyroid dysfunction, or simply because of genetics.
*See, you don’t have to be pregnant to get weird skin pigmentation patterns.*

So what to do about it?
First, as always, prevention. Limit any predisposing factors (pretty obvious).
If that factor is pregnancy, know that the extra pigmentation will probably go away without treatment by a year following delivery. If it doesn’t, you can start with the treatment options below.
If birth control pills are the inciting culprit, you can change your pill, use a different form of birth control, or cut your losses.
General sun exposure is an easy one – limit it! You should wear an SPF on your face every day anyway to prevent sun damage and prevent premature aging. So get on that, even if you don’t have melasma. You can also wear a hat (but please, style does count).
With seizure medications, or other medical problems, please ask your doctor before you do anything.
If genetics is at the root of your problem, there’s not much you can do. Move on to the treatment area below.

How can I treat it?
First line therapy is topical bleaching agents: hydroquinone, with or without glycolic acid or tretinoin. You can buy 2% hydroquinone over the counter. For a more potent treatment, or to combine it with these other agents, I would recommend making an appointment with a dermatologist. You want to improve your skin, not wreck it.

If this topical treatment doesn’t work, you can move to chemical peels, then laser treatments, or dermabrasion. Any of these may cause a temporary scary Halloween effect too, so be prepared for a potential 10 days of healing, all the while you contemplate wearing a mask to hide the treatment side effects for your mask.

Source: UptoDate “Melasma” and “Skin changes in pregnancy”