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Use of Oral Contraceptives in Women with Migraine
Buse DC, Loder EW, Golub JR.
Posted: July 2006  
Headache Care 2005;2:183-191

Migraine prevalence is highest in women during their childbearing years, when decisions about contraception must be made. Oral contraceptives (OCs) are the most reliable form of reversible birth control and are widely used by women around the world. OC use in women who have migraine is controversial, based on concerns about both safety and tolerability. Increases in headache frequency and intensity are often correctly or incorrectly attributed to OCs, and women are frequently advised to discontinue or avoid OCs when they consult their physicians about headache. Nonmigraine types of headache do not pose any contraindication to OC use. Migraine and OC use are independent risk factors for ischemic stroke, and thus OC use in migraineurs who have additional stroke risk factors is generally discouraged. Migraine is not an absolute contraindication to OC use, but the type of migraine and other patient factors must be reviewed before OC use can be recommended. This article discusses clinical trial evidence about the safety and tolerability of OCs in women with migraine headache. Guidelines issued by the American College of Obstetrics and Gynecology and the World Health Organization are reviewed, and their implications for patient care are considered.