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Reviews In Obstetrics and Gynecology. 2010 Spring; 3(2):55-65.Migraine affects as many as 37% of reproductive-age women in the United States. Hormonal contraception is the most frequently used form of birth control during the reproductive years, and given the significant proportion of reproductive-age women affected by migraine, there are several clinical considerations that arise when considering hormonal contraceptives in this population. In this review, key differences among headache, migraine, and migraine with aura, as well as strict diagnostic criteria, are described. The recommendations of the World Health Organization and the American College of Obstetricians and Gynecologists regarding hormonal contraception initiation and continuation in women with these diagnoses are emphasized. Finally, information about the effect of hormonal fluctuations on headache is provided with recommendations regarding contraception counseling in patients who experience headache while taking hormonal contraception.
Obstetrics and Gynecology. 2008 Sep; 112(3):572-8.OBJECTIVE: To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. METHODS: Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought birth control pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. The women then were interviewed by a blinded nurse practitioner, who also measured blood pressure. RESULTS: The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% confidence interval [CI] 51.7-60.6%), and specificity was 57.6% (95% CI 54.0-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5-86.3%), and specificity was 88.8% (95% CI 86.3-90.9%). Using the checklist, 6.6% (95% CI 5.2-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely because of unrecognized hypertension. Seven percent (95% CI 5.4-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily because of misclassification of migraine headaches. In regression analysis, younger women, more educated women, and Spanish speakers were significantly more likely to correctly self-screen (P<.05). CONCLUSION: Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method likely would be safe, especially for younger women and if independent blood pressure screening were encouraged.
Use of combined oral contraceptives among women with migraine and nonmigrainous headaches: a systematic review.
Contraception. 2006 Feb; 73(2):189-194.This systematic review examines evidence evaluating whether women with headaches who use combined oral contraceptives (COCs) have a greater risk of stroke than women with headaches who do not use COCs. We searched MEDLINE for articles published from 1966 through March 2005 relevant to headaches and COC use as risk factors for stroke. Of the 79 articles identified, nine met our selection criteria (eight reports of six observational studies plus one meta-analysis). All studies reported specifically on migraine headaches. Evidence from six case-control studies suggested that COC users with a history of migraine were two to four times as likely to have an ischemic stroke as nonusers with a history of migraine. The odds ratios for ischemic stroke ranged from 6 to almost 14 for COC users with migraine compared with nonusers without migraine. The three studies that provided evidence on hemorrhagic stroke reported low or no risk associated with migraine or with COC use. (author's)
Obstetrics and Gynecology. 2002 Jun; 99(6):1100-1112.The objective of this study is to review new evidence regarding 10 controversial issues in the use of contraceptive methods among women with special conditions and to present WHO recommendations derived in part from this evidence. The authors searched MEDLINE and PREMEDLINE databases for English-language articles, published between January 1995 and December 2001, for evidence relevant to 10 key contraceptive method and condition combinations: combined oral contraceptive (OC) use among women with hypertension or headaches, combined OC use for emergency contraception and adverse events, progestogen-only contraception use among young women and among breastfeeding women, tubal sterilization among young women, hormonal contraception and IUD use among women who are HIV positive, have AIDS, or are at high risk of HIV infection. Search terms included: "contraception," "contraceptives, oral," "progestational hormones," "medroxyprogesterone-17" acetate," "norenthindrone," "levonorgestrel," "Norplant," "contraceptives, postcoital," "sterilization, tubal," "IUDs," "hypertension," "stroke," "myocardial infarction," "thrombosis," "headache," "migraine," "adverse effects," "bone mineral density," "breastfeeding," "lactation," "age factors," "regret," and "HIV". From 205 articles, the authors identified 33 studies published in peer-reviewed journals that specifically examined risks of contraceptive use among women with pre-existing conditions. Combined OC users with hypertension appear to be at increased risk of myocardial infarction and stroke relative to users without hypertension. Combined OC users with migraine appear to be at increased risk of stroke relative to non-users with migraine. The evidence for the other eight method and condition combinations was either insufficient to draw conclusions or identified no excess risk. Of the 10 contraceptive method and condition combinations assessed, the evidence supported an increased risk of cardiovascular complications with combined OC use by women with hypertension or migraine. As a new evidence becomes available, assessment of risk and recommendations for use of contraceptive methods can be revised accordingly. (author's)