MIGRAINE AND ORAL-CONTRACEPTIVES

initiation of oral contraceptive (OC) therapy in migraine may worsen p re-existing migraine or change the pattern of the individual migraine attacks. Many women experience no change in their migraine and a few s how improvement. Evidence is accumulating that migraine increases isch emic stroke risk and that this risk is higher in migraine with aura th an in migraine without aura. OCs also increase stroke risk, and the in creased stroke risk attributable to each of migraine and OC therapy ma y be additive. The risk of ischemic stroke in young women is very low and likely remains acceptably low in young women with migraine without aura and in those with a simple migraine aura when OCs are prescribed . However, the presence of a complex or prolonged migraine aura, or of additional stroke risk factors such as increased age, smoking, and hy pertension likely increases the ischemic stroke risk further in patien ts with migraine when OCs are prescribed. Whether OCs can be prescribe d safely for the patient with migraine depends upon many factors inclu ding patient age, type of migraine, and the presence or absence of oth er stroke risk factors.