Abstract
Background
Migraine is common among women of reproductive age and is associated with an increased
risk of ischemic stroke. Combined oral contraceptives (COCs) are also associated with
an increased risk of ischemic stroke. Use of hormonal contraception among women with
migraine might further elevate the risk of stroke among women of reproductive age.
Objective
To identify evidence regarding the risk of arterial thromboembolism (stroke or myocardial
infarction) among women with migraine who use hormonal contraceptives.
Methods
We searched the PubMed database for all articles published from database inception
through January 2016. We included studies that examined women with migraine overall
or separated by subtype (with or without aura). Hormonal contraceptives of interest
included combined hormonal methods (COCs, patch and ring) and progestin-only methods
(progestin-only pills, injectables, implants and progestin intrauterine devices).
Results
Seven articles met inclusion criteria. All were case–control studies of fair to poor
quality reporting on use of COCs or oral contraceptives (OCs) not further described
and all reported stroke outcomes. Four studies demonstrated that, among women with
migraine (not separated by subtype), COC use was associated with approximately two
to four times the risk of stroke compared with nonuse. The only study to examine specific
migraine subtypes found an elevated risk of stroke among women with migraine with
aura, and this risk was similar regardless of OC use, although these odds ratios were
not reported. Two studies did not report risks among women with migraine and COC use
combined, but both found increased risks of stroke with migraine and COC use independently.
No evidence was found on other hormonal contraceptives or on risk of myocardial infarction.
Conclusion
Limited evidence suggests a two- to fourfold increased risk of stroke among women
with migraine who use COCs compared with nonuse. Additional study is needed on the
risks of hormonal contraceptives, including combined and progestin-only methods, among
women with different migraine subtypes.
Keywords
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References
- Migraine in women: the role of hormones and their impact on vascular diseases.J Headache Pain. 2012; 13: 177-189
- The international classification of headache disorders, 3rd edition (beta version).Cephalalgia. 2013; 33: 629-808
- Migraine and stroke: a complex association with clinical implications.Lancet Neurol. 2012; 1192-100
- The association of migraine with ischemic stroke.Curr Neurol Neurosci Rep. 2010; 10: 133-139
- Current use of oral contraceptives and the risk of first-ever ischemic stroke: a meta-analysis of observational studies.Thromb Res. 2015; 136: 52-60
- Migraine management during menstruation and menopause.Continuum. 2015; 21990-1003
- U.S. medical eligibility criteria for contraceptive use, 2010.MMWR Recomm Rep. 2010; 591-86
- Use of combined oral contraceptives among women with migraine and nonmigrainous headaches: a systematic review.Contraception. 2006; 73: 189-194
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Br Med J. 2009; 339: b2535
- Risk of acute thromboembolic events with oral contraceptive use: a systematic review and meta-analysis.Obstet Gynecol. 2013; 122: 380-389
- Current methods of the US preventive services task force: a review of the process.Am J Prev Med. 2001; 20: 21-35
- Associated risk factors.J Am Med Assoc. 1975; 231: 718-722
- Migraine and stroke in young women: case–control study. The World Health Organisation collaborative study of cardiovascular disease and steroid hormone contraception.Br Med J. 1999; 318: 13-18
- Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease.Br J Obstet Gynaecol. 1995; 102: 153-159
- Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study.Stroke. 2007; 38: 2438-2445
- Ischemic stroke in young women: a nested case–control study using the UK general practice research database.Stroke. 2004; 35: 1574-1578
- Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies.Stroke. 1998; 29: 2277-2284
- Case–control study of migraine and risk of ischaemic stroke in young women.Br Med J. 1995; 310: 830-833
- Ischemic stroke risk with oral contraceptives: a meta-analysis.J Am Med Assoc. 2000; 284: 72-78
- Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies.Br Med J. 2005; 330: 63
- Migraine and cardiovascular disease: systematic review and meta-analysis.Br Med J. 2009; 339: b3914
- Migraine headache and ischemic stroke risk: an updated meta-analysis.Am J Med. 2010; 123: 612-624
- Migraine and stroke: “vascular” comorbidity.Front Neurol. 2014; 5193
- History of migraine and risk of cerebral ischaemia in young adults. The Italian National Research Council study group on stroke in the young.Lancet. 1996; 347: 1503-1506
- Thrombotic stroke and myocardial infarction with hormonal contraception.N Engl J Med. 2012; 366: 2257-2266
- Combined hormonal contraceptives: is it time to reassess their role in migraine?.Headache. 2012; 52: 648-660
- Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives.in: Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. 57. 1998: 315-324
- Oral progestogen-only contraceptives and cardiovascular risk: results from the transnational study on oral contraceptives and the health of young women.Eur J Contracept Reprod Health Care. 1999; 4: 67-73
- Oral contraception and risk of a cerebral thromboembolic attack: results of a case–control study.Br Med J. 1993; 306: 956-963
- Contraceptives and cerebral thrombosis: a five-year national case–control study.Contraception. 2002; 65: 197-205
- Norplant implants and cardiovascular disease.Contraception. 1998; 57: 361-362
- Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2011; 42: 517-584
- Migraine and hemorrhagic stroke: a meta-analysis.Stroke. 2013; 44: 3032-3038
- Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age.J Neurol Neurosurg Psychiatry. 2002; 73: 747-750
- Migraine frequency and risk of cardiovascular disease in women.Neurology. 2009; 73: 581-588
- Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 3754-3832
- Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 1545-1588
- Collaborative group for the study of stroke in young women.N Engl J Med. 1973; 288: 871-878
Article info
Publication history
Published online: May 03, 2016
Accepted:
April 26,
2016
Received in revised form:
April 25,
2016
Received:
March 10,
2016
Footnotes
☆Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.
Identification
Copyright
Published by Elsevier Inc.
