Women with no significant medical history have many medically appropriate forms of contraception from which to choose. The options narrow when counseling a woman with episodic or chronic health conditions such as headache disorders. 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.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.2
Migraine must be distinguished from other types of headaches, such as tension-type headache, prior to contraceptive counseling (Table 1). Migraine headaches are diagnosed clinically and are classified as a recurrent disorder. The International Headache Society (IHS) provides diagnostic criteria for migraine using the the International Classification of Headache Disorders III criteria (Table 2).3 Migraine without aura is the most common subset of migraine, with a 1-year prevalence in women of 11%.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. Aura symptoms are reversible and can include visual, sensory, speech, language, motor, brainstem, and retinal symptoms.3 Though less common, migraine with aura has a 1-year prevalence of 5% in females (Table 3).4
|A. Photophobia||B. Length of time of headache||C. Vomiting||D. Shimmering Lines|
The authors report no potential conflicts of interest with regard to this article.
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