Oral contraceptives in migraine

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

Source: Expert Review of Neurotherapeutics, Volume 9, Number 3, March 2009 , pp. 381-393(13)

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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.

Keywords: combined oral contraceptives; ischemic stroke; migraine; safety; thrombophilia; tolerability

Document Type: Research article

DOI: http://dx.doi.org/10.1586/14737175.9.3.381

Affiliations: 1: Women's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Via Ventimiglia 3, I-10126 Turin, Italy., Email: gb.allais@tiscali.it

Publication date: 2009-03-01

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Expert Review of Neurotherapeutics provides expert commentary on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer's and Parkinson's.
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Oral contraceptives in migraine

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