Migraine and use of combined hormonal contraceptives: a clinical review.

Headache is a common condition affecting the majority of women at some time in their lives. Epidemiological studies of migraine also confirm that up to one-third of women will experience migraine, particularly during their fertile years. Studies suggesting that migraine in young women is associated with an increased risk ischaemic stroke have led to particular concerns regarding the additional effect of other risk factors such as use of combined oral contraceptives (COCs). This paper reviews the effect that COCs have on headache and migraine and considers the data on the risk of ischaemic stroke in COC users with migraine. This evidence will be used to support practical guidance on the management of women with migraine wishing to use COCs. Whilst the evidence presented is based on studies of COCs, there is no evidence to suggest that the effects of other combined hormonal contraceptives (CHCs) are any different. Until further data are available on the different routes of delivery, the following recommendations apply to all CHCs.