Contraception and Headache
Article first published online: 22 FEB 2013
© 2013 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 53, Issue 2, pages 247–276, February 2013
How to Cite
MacGregor, E. A. (2013), Contraception and Headache. Headache: The Journal of Head and Face Pain, 53: 247–276. doi: 10.1111/head.12035
- Issue published online: 22 FEB 2013
- Article first published online: 22 FEB 2013
- Manuscript Accepted: 26 NOV 2012
- ischemic stroke
Most women have used at least 1 method of contraception during their reproductive years, with the majority favoring combined oral contraceptives. Women are often concerned about the safety of their method of choice and also ask about likely effects on their pre-existing headache or migraine and restrictions on using their headache medication.
While there should be no restriction to the use of combined hormonal contraceptives by women with migraine without aura, the balance of risks vs benefits for women with aura are debatable. Migraine with aura, but not migraine without aura, is associated with a twofold increased risk of ischemic stroke, although the absolute risk is very low in healthy, nonsmoking women. Although ethinylestradiol has been associated with increased risk of ischemic stroke, the risk is dose-dependent. Low-dose pills currently used are considerably safer than pills containing higher doses of ethinylestradiol but they are not risk-free.
This review examines the evidence available regarding the effect that different methods of contraception have on headache and migraine and identifies strategies available to minimize risk and to manage specific triggers such as estrogen “withdrawal” headache and migraine associated with combined hormonal contraceptives. The independent risks of ischemic stroke associated with migraine and with hormonal contraceptives are reviewed, and guidelines for use of contraception by women with migraine are discussed in light of the current evidence.