Dealing with migraines is enough of a headache. But if you’re on birth control, it gets even more complicated. Women who get migraines and use newer forms of combination birth control, which involve two or more hormones, are at greater risk of blood clots and stroke, finds new research out of Brigham and Women’s Hospital. The risk is higher if you have migraines with aura—those delightful visual hallucinations that accompany your headache.

Researchers analyzed the medical records of 145,304 women who were using combination birth control between 2001 and 2012. They found that women with migraines had an increased risk of blood clots or stroke compared to women without migraines. A smaller subset, women with migraines with aura, were at even greater risk. The highest-risk group of all? Women who had migraines with aura who were also taking newer forms of combination birth control, such as YAZ, the patch, and the NuvaRing. According to the research, 7.6 percent of women with migraines with aura who used drospirenone-ethinyl estradiol (aka YAZ) were diagnosed with blood clots, compared with 6.3 percent of women with aura-free migraines who were also on the birth control (stats about women who fell into other groups who were diagnosed with blood clots haven’t yet been released).

The researchers stress that the data is just preliminary. But the study builds on decades of research linking migraines with aura to increased cardiovascular risk, particularly for women on birth control. Having migraines already puts you at risk of having heart problems, says Tobias Kurth, MD, adjunct associate professor of epidemiology at the Harvard School of Public Health, who was not involved with the study. And it’s well-known that blood clots are a potential side effect of using birth control. Together, migraines and birth control may increase your risk levels, says Kurth. That said, it’s important to note that the research may have some confounding variables. For instance, it’s possible that more people with migraines are prescribed the newer forms of birth control because so much research links the older forms with cardiovascular risk. When those people get a stroke or blood clot, it’s not clear if it’s caused by the new birth control or their pre-existing condition.

Kurth says that if you’re on birth control and susceptible to migraines, it’s best to discuss your options with your doctor. One thing to keep in mind: Lighting up puts you in even greater danger. If you suffer from migraines with aura and are on birth control, you absolutely have to stop smoking—or give up the oral contraceptives, says Kurth.

More From Women’s Health:
5 Ways to Prevent and Treat Migraines
Sneaky Headache Triggers to Avoid
Side Effects of Birth Control

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