Hello, and I hope I can answer your question. You should do a pregnancy test to make sure you are not pregnant. Pregnancy is extremely rare with the Mirena, but if you are pregnant it can be a tubal pregnancy which is an emergency situation if not treated promptly by a doctor, so I suggest you check a test to make sure. Secondly, you should see a GYN doctor or your women s health care provider for a pelvic examination to make sure your IUD is still present and in the right place. Irregular bleeding and spotting can occur with the Mirena, even a long time after insertion. They may also be able to do other hormone tests to evaluate your other symptoms. Migraines cause headaches frequently with nausea, and can be affected by hormonal contraception. I hope this advice was helpful, but a physical examination and possibly an ultrasound and blood tests may be necessary to find the origin of your symptoms. I hope you feel better and am able to get a diagnosis of your problem. Best wishes and feel better, Dr. Brown