Choosing Contraception for Women With Migraine

What are the current recommendations for hormonal contraception (eg, oralcontraceptives, medroxyprogesterone injections) in patients with migraine?
-Joanne E. Steane, MD
  Laramie, Wyo
Most physicians avoid prescribing oral contraceptives that containestrogen for women whose migraines are accompaniedby neurologic symptoms, such as weakness or numbness.Some clinicians are also hesitant to use combination agentsin patients with significant aura.
Several years ago, there was concern that the high level of estrogen inoral contraceptives might cause vascular complications. However, current combinationdrugs have a much lower level of estrogen. Nonetheless, if a womanwho has migraine with aura takes oral contraceptives, other risk factors-suchas smoking or high blood pressure-need to be controlled.
I am unaware of any strong data on the effects of progesterone in womenwith migraine; however, I do not think medroxyprogesterone injections arecontraindicated in this setting.
-Robert Kunkel, MD
  Headache Center
  Department of Neurology
  The Cleveland Clinic Foundation