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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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.
