Use of oral contraceptives in patients with migraine

Migraine is most common in women in their childbearing years, the same popu lation that also uses oral contraceptives (OCs). OC use can result in worse ning, improvement, or no change in a woman's migraine. The pattern of the m igraine attack may also change with, e.g., worsening of a pre-existing migr aine aura. There is evidence that migraine with aura is a significant risk factor for ischemic stroke, with an odds ratio of approximately 6. Migraine without aura appears to result in much less increase in ischemic stroke ri sk, although it may still be significant. OCs, even those with an estrogen content of less than 50 mu g, appear to cause an increase in ischemic strok e risk with an odds ratio of approximately 2, although the risk has been le ss in some studies. OC use in some patients with migraine with aura may lea d to unacceptable ischemic stroke risk, because this results in the combina tion of two stroke risk factors. It is recommended that, when OCs are presc ribed for patients with migraine, the potential risks and benefits be discu ssed with the patient and patients should be monitored for possible changes in their migraine. Caution should be exercised in OC use by women who have migraine with aura, especially older women and those who have other stroke risk factors. Pill use should be strongly discouraged in women who have a migraine aura beyond the ordinary or who develop new aura symptoms while ta king OCs.