Use of oral contraceptives in patients with migraine

Migraine is most common in women in their childbearing years, the same population that also uses oral contraceptives (OCs). OC use can result in worsening, improvement, or no change in a woman's migraine. The pattern of the migraine attack may also change with, e.g., worsening of a pre-existing migraine aura. There is evidence that migraine with aura is a significant risk factor for ischemic stroke, with an odds ratio of approximately 6. Migraine without aura appears to result in much less increase in ischemic stroke risk, although it may still be significant. OCs, even those with an estrogen content of less than 50 microg, appear to cause an increase in ischemic stroke risk with an odds ratio of approximately 2, although the risk has been less in some studies. OC use in some patients with migraine with aura may lead to unacceptable ischemic stroke risk, because this results in the combination of two stroke risk factors. It is recommended that, when OCs are prescribed for patients with migraine, the potential risks and benefits be discussed with the patient and patients should be monitored for possible changes in their migraine. Caution should be exercised in OC use by women who have migraine with aura, especially older women and those who have other stroke risk factors. Pill use should be strongly discouraged in women who have a migraine aura beyond the ordinary or who develop new aura symptoms while taking OCs.