The results of a recent study are consistent with an additive increase in stroke risk with combined hormonal contraceptives (CHC) use in women who have migraine with aura. Since the absolute risk of stroke is low even in the presence of these risk factors, use of CHCs in women who have migraine with aura should be based on an individualized assessment of harms and benefits. Researchers conducted a literature search of PubMed, the Cochrane Library, and EMBASE from inception through January 2016 for relevant studies. They included studies that examined exposure to CHCs and reported outcomes of ischemic or hemorrhagic stroke. They found:
- Of 2480 records, 15 studies met inclusion criteria.
- No studies reported odds ratios for stroke risk as a function of estrogen dose in women with migraine, largely due to insufficient sample sizes.
- No interaction effect between migraine and CHCs was seen in the 7 studies that assessed this.
- One study differentiated risk by presence or absence of migraine aura and found an increased risk in the migraine with aura population.
Risk of stroke associated with use of estrogen containing contraceptives in women with migraine: A systematic review. [Published online ahead of print November 15, 2017]. Headache. doi:10.1111/head.13229.