Oral Contraceptives in Migraine

Gianni Allais; Ilaria Castagnoli Gabellari; Cristina De Lorenzo; Ornella Mana; Chiara Benedetto

Disclosures

Expert Rev Neurother. 2009;9(3):381-393. 

In This Article

Abstract and Introduction

Abstract

Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear. The newest combined oral contraceptive formulations are generally well tolerated in migraine without aura, and the majority of migraine without aura sufferers do not show any problems with their use; nevertheless, the last International Classification of Headache Disorders identifies at least two entities evidently related to the use of combined oral contraceptives: exogenous hormone-induced headache and estrogen-withdrawal headache. As regards the safety, even if both migraine and combined oral contraceptive intake are associated with an increased risk of ischemic stroke, migraine without aura per se is not a contraindication for combined oral contraceptive use. Other risk factors (tobacco use, hypertension, hyperlipidemia, obesity and diabetes) must be carefully considered when prescribing combined oral contraceptives in migraine without aura patients, in particular in women aged over 35 years. Furthermore, the exclusion of a hereditary thrombophilia and of alterations of coagulative parameters should precede any decision of combined oral contraceptive prescription in migraine patients.

Introduction

For most women, combined oral contraceptives (COCs) are the preferred method of contraception because of their ease of use and proven efficacy.[1] COCs also provide many noncontraceptive health benefits, such as menstrual cycle control, treatment of dysfunctional uterine bleeding, protection against several gynecologic and nongynecologic cancers, preservation of bone density and improvement of acne.[2]

Since they are commonly associated with headache, however, physicians are frequently asked for advice regarding their interaction. In the specific case of migrainous women, physicians should always bear in mind the fact that COCs may raise two classes of problems: one regarding their tolerability, the other their safety. Both topics are reviewed in this paper.

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