Contraceptive use in women with migraine
Main Article Content
Abstract
Migraine affects approximately one in four women of childbearing age. There are a number of questions and concerns surrounding the use of contraceptives in women with migraine. This review examines the effects of various contraceptives on migraine and addresses the safety concerns, in particular reviewing the existing literature regarding the safety of oestrogen containing contraceptives in migraine. The aim of the review is to provide an overview of the issues and provide context and clarification in this potentially confusing area.
Article Details
How to Cite
AFRIDI, Dr Shazia.
Contraceptive use in women with migraine.
Medical Research Archives, [S.l.], v. 13, n. 4, apr. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6371>. Date accessed: 15 may 2025.
doi: https://doi.org/10.18103/mra.v13i4.6371.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Haakenstad A, Angelino O, Irvine CMS, et al. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022;400(10348):295-327 doi: 10.1016/S0140-6736(22)00936-9[published Online First: Epub Date]|.
3. Sarayani A, Winterstein A, Cristofoletti R, Vozmediano V, Schmidt S, Brown J. Real-world effect of a potential drug-drug interaction between topiramate and oral contraceptives on unintended pregnancy outcomes. Contraception 2023;120:10 9953 doi: 10.1016/j.contraception.2023.109953 [published Online First: Epub Date]|.
4. Borsook D, Erpelding N, Lebel A, et al. Sex and the migraine brain. Neurobiol Dis 2014;68: 200-14 doi: 10.1016/j.nbd.2014.03.008[published Online First: Epub Date]|.
5. MacGregor EA, Hackshaw A. Prevalence of migraine on each day of the natural menstrual cycle. Neurology 2004;63(2):351-3 doi: 10.1212/01.w nl.0000133134.68143.2e[published Online First: Epub Date]|.
6. Somerville BW. The role of estradiol withdrawal in the etiology of menstrual migraine. Neurology 1972;22(4):355-65 doi: 10.1212/wnl.2 2.4.355 [published Online First: Epub Date]|.
7. Ornello R, De Matteis E, Di Felice C, Caponnetto V, Pistoia F, Sacco S. Acute and Preventive Management of Migraine during Menstruation and Menopause. J Clin Med 2021;10 (11) doi: 10.3390/jcm10112263[published Online First: Epub Date]|.
8. Warfvinge K, Krause DN, Maddahi A, Edvinsson JCA, Edvinsson L, Haanes KA. Estrogen receptors alpha, beta and GPER in the CNS and trigeminal system - molecular and functional aspects. J Headache Pain 2020;21(1):131 doi: 10.1186/s101 94-020-01197-0[published Online First: Epub Date]|.
9. MacGregor EA. Oestrogen and attacks of migraine with and without aura. Lancet Neurol 2004;3(6):354-61 doi: 10.1016/S1474-4422(04)007 68-9[published Online First: Epub Date]|.
10. Chauvel V, Multon S, Schoenen J. Estrogen-dependent effects of 5-hydroxytryptophan on cortical spreading depression in rat: Modelling the serotonin-ovarian hormone interaction in migraine aura. Cephalalgia 2018;38(3):427-36 doi: 10.1177/0 333102417690891[published Online First: Epub Date]|.
11. Rustichelli C, Bellei E, Bergamini S, et al. Comparison of pregnenolone sulfate, pregnanolone and estradiol levels between patients with menstrually-related migraine and controls: an exploratory study. J Headache Pain 2021;22(1):13 doi: 10.1186/s1019 4-021-01231-9[published Online First: Epub Date]|.
12. MacGregor EA. Contraception and headache. Headache 2013;53(2):247-76 doi: 10.1111/head.1 2035[published Online First: Epub Date]|.
13. Sulak P, Willis S, Kuehl T, Coffee A, Clark J. Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 2007;47(1):27-37 doi: 10.1111/j.1526-4610.2007.00650.x[published Online First: Epub Date]|.
14. De Leo V, Scolaro V, Musacchio MC, Di Sabatino A, Morgante G, Cianci A. Combined oral contraceptives in women with menstrual migraine without aura. Fertil Steril 2011;96(4):917-20
doi:10.1016/j.fertnstert.2011.07.1089[published Online First: Epub Date]|.
15. Calhoun A, Ford S, Pruitt A. The impact of extended-cycle vaginal ring contraception on migraine aura: a retrospective case series. Headache 2012;52(8):1246-53 doi: 10.1111/j.1526-4610.201 2.02211.x[published Online First: Epub Date]|.
16. Edvinsson L, Haanes KA, Warfvinge K, Krause DN. CGRP as the target of new migraine therapies - successful translation from bench to clinic. Nat Rev Neurol 2018;14(6):338-50 doi: 10.1038/s41582-018-0003-1[published Online First: Epub Date]|.
17. Edvinsson L, Tajti J, Szalardy L, Vecsei L. PACAP and its role in primary headaches. J Headache Pain 2018;19(1):21 doi: 10.1186/s10194-018-0852-4[published Online First: Epub Date]|.
18. Storch E, Overeem LH, Terhart M, et al. PACAP-38 and sex hormones in women with migraine: exploratory analysis of a cross-sectional, matched cohort study. J Headache Pain 2024;25 (1):98 doi: 10.1186/s10194-024-01804-4[published Online First: Epub Date]|.
19. Raffaelli B, Storch E, Overeem LH, et al. Sex Hormones and Calcitonin Gene-Related Peptide in Women With Migraine: A Cross-sectional, Matched Cohort Study. Neurology 2023;100(17):e1825-e35 doi: 10.1212/WNL.0000000000207114[published Online First: Epub Date]|.
20. Warhurst S, Rofe CJ, Brew BJ, et al. Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis. Cephalalgia 2018;38(4):754-64
doi:10.1177/0333102417710636[published Online First: Epub Date]|.
21. Vetvik KG, MacGregor EA, Lundqvist C, Russell MB. Contraceptive-induced amenorrhoea leads to reduced migraine frequency in women with menstrual migraine without aura. J Headache Pain 2014;15(1):30 doi: 10.1186/1129-2377-15-30 [published Online First: Epub Date]|.
22. van Lohuizen R, Paungarttner J, Lampl C, MaassenVanDenBrink A, Al-Hassany L. Considerations for hormonal therapy in migraine patients: a critical review of current practice. Expert Rev Neurother 2023;24(1):1-21 doi: 10.1080/1473 7175.2023.2296610[published Online First: Epub Date]|.
23. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJ, Rosendaal FR. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ 2009;339: b2921 doi: 10.1136/bmj.b2921[published Online First: Epub Date]|.
24. Kurth T, Chabriat H, Bousser MG. Migraine and stroke: a complex association with clinical implications. Lancet Neurol 2012;11(1):92-100 doi:10.1016/S1474-4422(11)70266-6 [published Online First: Epub Date]|.
25. Kurth T, Slomke MA, Kase CS, et al. Migraine, headache, and the risk of stroke in women: a prospective study. Neurology 2005;64(6):1020-6 doi:10.1212/01.WNL.0000154528.21485.3A [published Online First: Epub Date]|.
26. Tietjen GE, Maly EF. Migraine and Ischemic Stroke in Women. A Narrative Review. Headache 2020;60(5):843-63 doi:10.1111/head.13796 [published Online First: Epub Date]|.
27. Mahmoud AN, Mentias A, Elgendy AY, et al. Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects. BMJ Open 2018;8(3):e020498 doi: 10.1136/bmjopen-2017-020498[published Online First: Epub Date]|.
28. Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009;339:b3914 doi:10.1136/bmj.b3914 [published Online First: Epub Date]|.
29. MacClellan LR, Giles W, Cole J, et al. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke 2007;38(9):2438-45 doi: 10.1161/STROKEAHA.10 7.488395 [published Online First: Epub Date]|.
30. Champaloux SW, Tepper NK, Monsour M, et al. Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Am J Obstet Gynecol 2017;216(5):489 e1-89 e7 doi:10.1016/j.ajog.2016.12.019[published Online First: Epub Date]|.
31. Xu Z, Li Y, Tang S, Huang X, Chen T. Current use of oral contraceptives and the risk of first-ever ischemic stroke: A meta-analysis of observational studies. Thromb Res 2015;136(1):52-60
doi:10.1016/j.thromres.2015.04.021[published Online First: Epub Date]|.
32. Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med 2012;366(24):2257-66 doi: 10.1056/N
EJMoa1111840 [published Online First: Epub Date]|.
33. Batur P, Yao M, Bucklan J, et al. Use of combined hormonal contraception and stroke: A case-control study of the impact of migraine type and estrogen dose on ischemic stroke risk. Headache 2023;63(6):813-21 doi:10.1111/head.14473 [published Online First: Epub Date]|.
34. Nightingale AL, Farmer RD. Ischemic stroke in young women: a nested case-control study using the UK General Practice Research Database. Stroke 2004;35(7):1574-8 doi:10.1161/01.STR.00001297 89.58837.e4 [published Online First: Epub Date]|.
35. Appendix D: Classifications for Combined Hormonal Contraceptives. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 2024
36. UK MEDICAL ELIGIBILITY CRITERIA FOR CONTRACEPTIVE USE The faculty of sexual and reprodutive healthcare 2019
37. Sacco S, Merki-Feld GS, KL AE, et al. Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). J Headache Pain 2017;18(1):108
doi:10.1186/s10194-017-0815-1 [published Online First: Epub Date]|.
2. Haakenstad A, Angelino O, Irvine CMS, et al. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022;400(10348):295-327 doi: 10.1016/S0140-6736(22)00936-9[published Online First: Epub Date]|.
3. Sarayani A, Winterstein A, Cristofoletti R, Vozmediano V, Schmidt S, Brown J. Real-world effect of a potential drug-drug interaction between topiramate and oral contraceptives on unintended pregnancy outcomes. Contraception 2023;120:10 9953 doi: 10.1016/j.contraception.2023.109953 [published Online First: Epub Date]|.
4. Borsook D, Erpelding N, Lebel A, et al. Sex and the migraine brain. Neurobiol Dis 2014;68: 200-14 doi: 10.1016/j.nbd.2014.03.008[published Online First: Epub Date]|.
5. MacGregor EA, Hackshaw A. Prevalence of migraine on each day of the natural menstrual cycle. Neurology 2004;63(2):351-3 doi: 10.1212/01.w nl.0000133134.68143.2e[published Online First: Epub Date]|.
6. Somerville BW. The role of estradiol withdrawal in the etiology of menstrual migraine. Neurology 1972;22(4):355-65 doi: 10.1212/wnl.2 2.4.355 [published Online First: Epub Date]|.
7. Ornello R, De Matteis E, Di Felice C, Caponnetto V, Pistoia F, Sacco S. Acute and Preventive Management of Migraine during Menstruation and Menopause. J Clin Med 2021;10 (11) doi: 10.3390/jcm10112263[published Online First: Epub Date]|.
8. Warfvinge K, Krause DN, Maddahi A, Edvinsson JCA, Edvinsson L, Haanes KA. Estrogen receptors alpha, beta and GPER in the CNS and trigeminal system - molecular and functional aspects. J Headache Pain 2020;21(1):131 doi: 10.1186/s101 94-020-01197-0[published Online First: Epub Date]|.
9. MacGregor EA. Oestrogen and attacks of migraine with and without aura. Lancet Neurol 2004;3(6):354-61 doi: 10.1016/S1474-4422(04)007 68-9[published Online First: Epub Date]|.
10. Chauvel V, Multon S, Schoenen J. Estrogen-dependent effects of 5-hydroxytryptophan on cortical spreading depression in rat: Modelling the serotonin-ovarian hormone interaction in migraine aura. Cephalalgia 2018;38(3):427-36 doi: 10.1177/0 333102417690891[published Online First: Epub Date]|.
11. Rustichelli C, Bellei E, Bergamini S, et al. Comparison of pregnenolone sulfate, pregnanolone and estradiol levels between patients with menstrually-related migraine and controls: an exploratory study. J Headache Pain 2021;22(1):13 doi: 10.1186/s1019 4-021-01231-9[published Online First: Epub Date]|.
12. MacGregor EA. Contraception and headache. Headache 2013;53(2):247-76 doi: 10.1111/head.1 2035[published Online First: Epub Date]|.
13. Sulak P, Willis S, Kuehl T, Coffee A, Clark J. Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 2007;47(1):27-37 doi: 10.1111/j.1526-4610.2007.00650.x[published Online First: Epub Date]|.
14. De Leo V, Scolaro V, Musacchio MC, Di Sabatino A, Morgante G, Cianci A. Combined oral contraceptives in women with menstrual migraine without aura. Fertil Steril 2011;96(4):917-20
doi:10.1016/j.fertnstert.2011.07.1089[published Online First: Epub Date]|.
15. Calhoun A, Ford S, Pruitt A. The impact of extended-cycle vaginal ring contraception on migraine aura: a retrospective case series. Headache 2012;52(8):1246-53 doi: 10.1111/j.1526-4610.201 2.02211.x[published Online First: Epub Date]|.
16. Edvinsson L, Haanes KA, Warfvinge K, Krause DN. CGRP as the target of new migraine therapies - successful translation from bench to clinic. Nat Rev Neurol 2018;14(6):338-50 doi: 10.1038/s41582-018-0003-1[published Online First: Epub Date]|.
17. Edvinsson L, Tajti J, Szalardy L, Vecsei L. PACAP and its role in primary headaches. J Headache Pain 2018;19(1):21 doi: 10.1186/s10194-018-0852-4[published Online First: Epub Date]|.
18. Storch E, Overeem LH, Terhart M, et al. PACAP-38 and sex hormones in women with migraine: exploratory analysis of a cross-sectional, matched cohort study. J Headache Pain 2024;25 (1):98 doi: 10.1186/s10194-024-01804-4[published Online First: Epub Date]|.
19. Raffaelli B, Storch E, Overeem LH, et al. Sex Hormones and Calcitonin Gene-Related Peptide in Women With Migraine: A Cross-sectional, Matched Cohort Study. Neurology 2023;100(17):e1825-e35 doi: 10.1212/WNL.0000000000207114[published Online First: Epub Date]|.
20. Warhurst S, Rofe CJ, Brew BJ, et al. Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis. Cephalalgia 2018;38(4):754-64
doi:10.1177/0333102417710636[published Online First: Epub Date]|.
21. Vetvik KG, MacGregor EA, Lundqvist C, Russell MB. Contraceptive-induced amenorrhoea leads to reduced migraine frequency in women with menstrual migraine without aura. J Headache Pain 2014;15(1):30 doi: 10.1186/1129-2377-15-30 [published Online First: Epub Date]|.
22. van Lohuizen R, Paungarttner J, Lampl C, MaassenVanDenBrink A, Al-Hassany L. Considerations for hormonal therapy in migraine patients: a critical review of current practice. Expert Rev Neurother 2023;24(1):1-21 doi: 10.1080/1473 7175.2023.2296610[published Online First: Epub Date]|.
23. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJ, Rosendaal FR. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ 2009;339: b2921 doi: 10.1136/bmj.b2921[published Online First: Epub Date]|.
24. Kurth T, Chabriat H, Bousser MG. Migraine and stroke: a complex association with clinical implications. Lancet Neurol 2012;11(1):92-100 doi:10.1016/S1474-4422(11)70266-6 [published Online First: Epub Date]|.
25. Kurth T, Slomke MA, Kase CS, et al. Migraine, headache, and the risk of stroke in women: a prospective study. Neurology 2005;64(6):1020-6 doi:10.1212/01.WNL.0000154528.21485.3A [published Online First: Epub Date]|.
26. Tietjen GE, Maly EF. Migraine and Ischemic Stroke in Women. A Narrative Review. Headache 2020;60(5):843-63 doi:10.1111/head.13796 [published Online First: Epub Date]|.
27. Mahmoud AN, Mentias A, Elgendy AY, et al. Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects. BMJ Open 2018;8(3):e020498 doi: 10.1136/bmjopen-2017-020498[published Online First: Epub Date]|.
28. Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009;339:b3914 doi:10.1136/bmj.b3914 [published Online First: Epub Date]|.
29. MacClellan LR, Giles W, Cole J, et al. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke 2007;38(9):2438-45 doi: 10.1161/STROKEAHA.10 7.488395 [published Online First: Epub Date]|.
30. Champaloux SW, Tepper NK, Monsour M, et al. Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Am J Obstet Gynecol 2017;216(5):489 e1-89 e7 doi:10.1016/j.ajog.2016.12.019[published Online First: Epub Date]|.
31. Xu Z, Li Y, Tang S, Huang X, Chen T. Current use of oral contraceptives and the risk of first-ever ischemic stroke: A meta-analysis of observational studies. Thromb Res 2015;136(1):52-60
doi:10.1016/j.thromres.2015.04.021[published Online First: Epub Date]|.
32. Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med 2012;366(24):2257-66 doi: 10.1056/N
EJMoa1111840 [published Online First: Epub Date]|.
33. Batur P, Yao M, Bucklan J, et al. Use of combined hormonal contraception and stroke: A case-control study of the impact of migraine type and estrogen dose on ischemic stroke risk. Headache 2023;63(6):813-21 doi:10.1111/head.14473 [published Online First: Epub Date]|.
34. Nightingale AL, Farmer RD. Ischemic stroke in young women: a nested case-control study using the UK General Practice Research Database. Stroke 2004;35(7):1574-8 doi:10.1161/01.STR.00001297 89.58837.e4 [published Online First: Epub Date]|.
35. Appendix D: Classifications for Combined Hormonal Contraceptives. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 2024
36. UK MEDICAL ELIGIBILITY CRITERIA FOR CONTRACEPTIVE USE The faculty of sexual and reprodutive healthcare 2019
37. Sacco S, Merki-Feld GS, KL AE, et al. Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). J Headache Pain 2017;18(1):108
doi:10.1186/s10194-017-0815-1 [published Online First: Epub Date]|.