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Migraine and Oral Contraceptives

Published online by Cambridge University Press:  18 September 2015

W.J. Becker
W.J. Becker*
Affiliation:
University of Calgary and Calgary General Hospital, Bow Valley Centre, Calgary.
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Abstract:

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Initiation of oral contraceptive (OC) therapy in migraine may worsen pre-existing migraine or change the pattern of the individual migraine attacks. Many women experience no change in their migraine and a few show improvement. Evidence is accumulating that migraine increases ischemic stroke risk and that this risk is higher in migraine with aura than in migraine without aura. OCs also increase stroke risk, and the increased stroke risk attributable to each of migraine and OC therapy may 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 hypertension likely increases the ischemic stroke risk further in patients with migraine when OCs are prescribed. Whether OCs can be prescribed safely for the patient with migraine depends upon many factors including patient age, type of migraine, and the presence or absence of other stroke risk factors.

Résumé:

RÉSUMÉ:

La prise de contraceptifs oraux peut aggraver les symptômes chez une migraineuse ou modifier le tableau clinique lors des crises. Plusieurs femmes ne présentent pas de changement de leur symptomatologie migraineuse et un petit nombre note une amélioration. II y a de plus en plus d'évidence que la migraine augmente le risque d'accident vasculaire cérébral ischémique et que ce risque est plus éevé dans la migraine avec aura que dans la migraine sans aura. Les contraceptifs oraux augmentent également le risque d'accident vasculaire cérébral et les risques accrus d'accident vasculaire cérébral attribuable à chacun pourraient être additifs. Le risque d'un accident vasculaire càrébral ischémique chez une femmejeune est très faible et demeurera probablement àun niveau acceptable chez les jeunes femmes migraineuses sans aura et chez celles qui ont une aura simple quand les contraceptifs oraux sont prescrits. Cependant, la présence de migraine avec aura complexe ou prolongée ou de facteurs de risque additionnels d'accident vasculaire cérébral tels que l'âge, le tabagisme et l'hypertension augmente vraisemblablement davantage le risque d'accident vasculaire cérébral ischémique chez les migraineuses quand on present des contraceptifs oraux. La sécurité de la prescription de contraceptifs oraux chez les patientes migraineuses dépend de plusieurs facteurs incluant l'âge de la patiente, le type de migraine et la présence ou l'absence d'autres facteurs de risque d'accident vasculaire cérébral.

Type
Review Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 1 , February 1997 , pp. 16 - 21
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

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