Combined hormonal contraceptives and migraine: An update on the evidence

Cleveland Clinic Journal of Medicine. August 2017 

Author(s): Anne H. Calhoun, MD, FAHS  Pelin Batur, MD, FACP, NCM

This article reviews migraine diagnosis, the effects of estrogen and the menstrual cycle on migraine, the evidence of stroke risk with combined hormonal contraceptive use, and how the frequency of aura may affect risk.

KEY POINTS

  • There is no restriction on the use of combined hormonal contraceptives by women with migraine without aura, and the risk vs benefit for women with aura is debatable.
  • Migraine with aura—but not migraine without aura—is associated with a twofold increased risk of ischemic stroke, although the absolute risk is small in healthy women who do not smoke.
  • Combined hormonal contraceptives are associated with ischemic stroke, but the risk is dose-dependent. Ultra-low-dose formulations (containing ≤ 20 μg of ethinyl estradiol) do not pose an increased risk of stroke in healthy nonsmokers.

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