Contraception and Headache
Corresponding Author
E. Anne MacGregor MD
Barts Health NHS Trust, London, UK
Centre for Neuroscience & Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
Address all correspondence to E.A. MacGregor, Barts Sexual Health Centre, Kenton and Lucas Block, St. Bartholomew's Hospital, London, EC1A 7BE, UK.Search for more papers by this authorCorresponding Author
E. Anne MacGregor MD
Barts Health NHS Trust, London, UK
Centre for Neuroscience & Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
Address all correspondence to E.A. MacGregor, Barts Sexual Health Centre, Kenton and Lucas Block, St. Bartholomew's Hospital, London, EC1A 7BE, UK.Search for more papers by this authorAbstract
Most women have used at least 1 method of contraception during their reproductive years, with the majority favoring combined oral contraceptives. Women are often concerned about the safety of their method of choice and also ask about likely effects on their pre-existing headache or migraine and restrictions on using their headache medication.
While there should be no restriction to the use of combined hormonal contraceptives by women with migraine without aura, the balance of risks vs benefits for women with aura are debatable. Migraine with aura, but not migraine without aura, is associated with a twofold increased risk of ischemic stroke, although the absolute risk is very low in healthy, nonsmoking women. Although ethinylestradiol has been associated with increased risk of ischemic stroke, the risk is dose-dependent. Low-dose pills currently used are considerably safer than pills containing higher doses of ethinylestradiol but they are not risk-free.
This review examines the evidence available regarding the effect that different methods of contraception have on headache and migraine and identifies strategies available to minimize risk and to manage specific triggers such as estrogen “withdrawal” headache and migraine associated with combined hormonal contraceptives. The independent risks of ischemic stroke associated with migraine and with hormonal contraceptives are reviewed, and guidelines for use of contraception by women with migraine are discussed in light of the current evidence.
Supporting Information
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Figure S1 Percent distribution of women aged 15-44 by contraceptive method: USA, 2006-2008. Based on data from: Mosher W, Jones J. Use of contraception in the USA: 1982-2008. National Center for Health Statistics. Vital Health Stat 23. 2010;29:1-44. Table S1 Formulations of currently marketed combined oral contraceptives. Table S2 Risk of headache associated with COC containing 20 mcg of EE vs COC containing 30-50 mcg EE. Table S3 Risk of headache leading to discontinuation of COC containing 20 mcg of EE vs COC containing 30-35 mcg of EE. Table S4 Risk ratio of headache associated with COC use according to type of progestin. Table S5 Risk ratio of headache leading to discontinuation of COC according to type of progestin. Table S6 Risk ratio of migraine associated with COC use according to type of progestin. Table S7 Risk ratio of migraine leading to discontinuation of COC according to type of progestin. Table S8 Medical Eligibility Criteria (MEC) for Contraceptive Use of progestin-only and Copper-IUD contraceptives (based on US, WHO, and UK MEC). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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