choice of oral contraceptive in patient with migraine

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  • a combined pill containing a low dose of oestrogen (i.e. 30 mcg) is indicated in women who have migraines without auras - this is because the risk of stroke is greater the higher the dose of oestrogen in the combined pill

  • a DTB review (1) suggests that low-dose pill can also be given to women who have migraines without auras but have one additional risk factor for stroke - however the review emphasises that these patients must be followed up carefully - note that this advice contrasts with that provided by the British National Formulary, which advises that if there are two or more risk factors for arterial disease then the combined oral contraceptive pill should be avoided

UKMEC Criteria state:

Cardiovascular factors (including migraine) and UKMEC categories (3):

In consideration of UKMEC criteria and combined hormonal contraception (CHC):

 

Check the summary of product characteristics before prescribing any combined oral contraceptive pill.

Reference:

  • (1)
  • Drug and Therapeutics Bulletin (2000), 38 (1), 1-4.
  • (2) BNF 7.3
  • (3) FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended July 2019)

Last edited 06/2020 and last reviewed 06/2020

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