![]() Migraine Migraine is a risk factor for ischemic stroke. Which of the patient’s symptoms would cause you to recommend against estrogen-containing contraceptive methods? ![]() She has a 1-year-old son, is no longer breastfeeding, and would like to wait 1 to 2 years before another pregnancy, and is hoping to start combined hormonal oral contraceptive pills. The woman’s headaches resolve after she lies in a dark quiet room and sleeps. Her headaches last 4 to 6 hours and she has associated nausea and occasional vomiting. ![]() Prior to her headache onset, the patient sometimes sees shimmering lines and other shapes in her vision. She has no significant medical history but on review of systems, reports experiencing headaches twice monthly. 4Ĭase A 27-year-old G1P1 presents for initiation of contraception. 3 Though less common, migraine with aura has a 1-year prevalence of 5% in females (Table 3). Aura symptoms are reversible and can include visual, sensory, speech, language, motor, brainstem, and retinal symptoms. 4 Migraine with aura includes all of the outlined migraine criteria, with the addition of a variety of neurological symptoms that can occur immediately before or with onset of the headache. 3 Migraine without aura is the most common subset of migraine, with a 1-year prevalence in women of 11%. The International Headache Society (IHS) provides diagnostic criteria for migraine using the the International Classification of Headache Disorders III criteria (Table 2). Migraine headaches are diagnosed clinically and are classified as a recurrent disorder. Migraine must be distinguished from other types of headaches, such as tension-type headache, prior to contraceptive counseling (Table 1). 1 With up to 20% of reproductive-aged women affected by migraine, it is important for ob/gyns to understand the risks and benefits of contraceptive hormone use in this population. Hormonal options are the most widely used forms of contraception among US women over 40% of women aged 15 to 44 use hormone-containing forms of birth control, including the pill, intrauterine device, implant, injectable, ring, or patch. The options narrow when counseling a woman with episodic or chronic health conditions such as headache disorders. Women with no significant medical history have many medically appropriate forms of contraception from which to choose.
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