1/19/2024 0 Comments Migraine with aura stroke![]() Withdrawal from estrogen also contributes to migraine susceptibility by decreasing serotonergic tone and affecting central opioid tonus. The characteristic steep estrogen drop in the luteal phase is thought to increase blood vessel permeability, leading to greater impact of pro-inflammatory mediators such as prostaglandins, which are elevated threefold during the same time period. The luteal phase of the menstrual cycle is a common trigger for migraine. ![]() Hormones may play a role in the pathogenesis of migraine, as evidenced by the relationship between migraine and the menstrual cycle. ![]() The purpose of this review is to present current research and to explore the risks versus benefits of contraceptive use among patients with migraines to help clinicians caring for these patients. ![]() Contrastingly, there is a growing research studies exploring possible benefits that patients with migraines may experience from hormonal contraceptives. The literature exploring contraception and migraines is expanding and more nuanced questions are being investigated, including whether there should be further risk stratification based on frequency of aura and how to appropriately weigh the risks of unintended pregnancy. This guidance stems from the fact that both CHCs and migraines with aura are independently associated with an increased risk of ischemic stroke however, the extent to which there is a synergistic effect when they are encountered together is based on limited studies. The American College of Obstetricians and Gynecologist (ACOG) and Centers Disease Control and Prevention (CDC) United States Medical Eligibility Criteria (USMEC) guidelines state that CHCs may be used in patients with migraines without aura who otherwise are at low risk for thrombosis, but cautions use of CHCs for women who have migraine with aura unless the benefits outweigh the risk (USMEC 3). There is an overlap in populations having migraines and using contraception, which raises the question of how clinicians can best counsel these patients.Ī concern raised when discussing contraceptive use in patients with migraines, particularly in the case of migraines with aura, is increased risk of ischemic stroke affiliated with combined hormonal contraceptives (CHCs). Īs of 2019, 65.3% of female individuals aged 15–49 in the USA were actively using some form of contraception, with oral contraceptive pills (OCPs) making up 14% of those users. Of patients with migraines, approximately 15 to 33% will experience migraines with auras. The lifetime incidence of migraine for women is 43% compared to men which is 18%, and the 1-year prevalence is nearly 3 times higher in women than in men (17% vs. Migraine is a leading cause of disability-adjusted life years in women aged 15–49, and there are biological sex disparities between those who experience migraines. Further studies are needed on migraine and specific formulations of CHC, if the frequency of migraines with aura impacts ischemic stroke risk and the impact of oral and non-oral contraceptives on menstrual headaches. In patients with menstrual-related migraines, there may be benefit from continuous use of oral contraceptives. CHC use is acceptable among patient with migraines without aura. SummaryĬertain guidelines recommend against use of CHCs in patients with migraine with aura. However, recent studies suggest that oral contraceptive may reduce migraine days, pain scores, and migraine medication use. ![]() The use of CHCs in patients with migraine with aura produces a higher risk of ischemic stroke than either factor individually therefore, CHC is contraindicated in this population by certain guidelines. Migraine with aura and combined hormonal contraceptive (CHC) use are associated with increased ischemic stroke risk. The purpose of this review is to present recent studies on contraception among patients with migraines and provide clinical recommendations. There is an overlap in the populations of patients who suffer from migraine headaches and patients who seek contraception. ![]()
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