SAN DIEGO—Among women with migraine, low-dose combined estrogen–progestin contraceptives do not increase the risk of stroke, and
continuous hormonal contraceptive use may reduce
menstrual migraine, according to a lecture delivered
at the 58th Annual Scientific Meeting of the American
High doses of combined oral contraceptives do in-
crease stroke risk, and migraine with aura confers an
independent increased risk of stroke, said Anne H.
Calhoun, MD, Professor of Anesthesiology and Psy-
chiatry at the University of North Carolina in Chapel
Hill and partner and cofounder of the Carolina Head-
ache Institute in Durham. Evidence does not suggest,
Over the last several decades, various combined
oral contraceptive regimens (eg, triphasic, extended
cycle, and continuous) with a range of estrogen doses
have been developed. “They are all over the place, and
we really need to know what we are dealing with,”
Dr. Calhoun said. Risks of combined oral contracep-
tives, including myocardial infarction and stroke, are
almost exclusively seen with smoking and high-dose
pills, she said.
Dr. Calhoun prefers to prescribe pills that inhibit
ovulation while using 20 μg or less of the synthetic
Volume 24, Number 11
Risk or Benefit in Migraine?
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