If you have migraine with aura, you should not use combined hormonal contraceptives - which means the combined oral contraceptive (COC) pill ('the pill'), the contraceptive vaginal ring ("the ring") or the contraceptive patch ('the patch').This is because of a small but significant increased risk of having a stroke. High-dose pills—which today contain 50 µg of ethinyl estradiol—account for less than 1 percent of pills currently sold in the United States and have been eliminated in many countries.Shortly after the first combined oral contraceptives were released, reports of adverse events began to appear, although serious events were relatively rare. New York Headache Center, 30 East 76th Street, Floor 2, New York, NY, 10021 USA. Copyright © 2020 American Headache Society®. Clearing this confusion is a key issue for headache specialists, since most women with migraine have menstrual-related migraine (MRM), and some CHCs can prevent this particularly severe migraine.

All rights reserved. We do not endorse non-Cleveland Clinic products or services Combined hormonal contraceptives are contraindicated in women who have migraine with aura because they pose a risk of stroke. Women who have menstrual-related migraine refractory to or who cannot tolerate other migraine therapies are often willing to try a low-dose estrogen-containing contraceptive for control of their migraine, especially if they have tried it in the past and believe that it helped prevent migraine. Patients should have follow-up within three months to discuss whether they have benefited from the regimen in terms of headache frequency or severity.

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Lynda J Krasenbaum MSN, ANP‐BC.

Studies have shown that the use of oral contraceptives may increase that risk, as they already carry a small but notable increased risk of ischemic stroke. … If a combined oral contraceptive is used in women with migraine with aura, lower estrogen doses (≤ 20 µg ethinyl estradiol) are preferred to decrease aura frequency and minimize the risk of stroke associated with high-dose ethinyl estradiol formulations.It is important to remember that the risks of unintended pregnancy are always greater than the risks of any contraceptive, especially in women with chronic medical conditions, including those who have migraine with aura.For a patient who has a history of migraine with aura, if the goal is only to prevent pregnancy, we would recommend another contraceptive option that does not involve estrogen. Consequently, they expose women to lower peak concentrations of estrogen than they would experience in their natural menstrual cycle.

But this contraindication is based on data from the 1960s and 1970s, when OCs contained much higher doses of estrogen.

Advertising on our site helps support our mission. S AN DIEGO —Among women with migraine, low-dose combined estrogen–progestin contraceptives do not increase the risk of stroke, and continuous hormonal contraceptive use may reduce menstrual migraine, according to a lecture delivered at the 58th Annual Scientific Meeting of the American Headache Society.. High doses of combined oral contraceptives do increase stroke risk, and migraine … Get the latest for primary care physicians from Cleveland Clinic- delivered right to your inbox. Associate Director. Cleveland Clinic is a non-profit academic medical center.

9500 Euclid Avenue , Cleveland , Ohio 44195 | 800.223.2273 | TTY 216.444.0261 In response, prescribing guidelines advised against giving oral contraceptives to women with a history of deep vein thrombosis, myocardial infarction, stroke, or hypertension. and you may need to create a new Wiley Online Library account.Enter your email address below and we will send you your usernameIf the address matches an existing account you will receive an email with instructions to retrieve your username

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