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Rev Obstet Gynecol. 2010 Spring;3(2):55-65.

Hormonal contraceptive options for women with headache: a review of the evidence.

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Department of Obstetrics and Gynecology, Brigham and Women's Hospital Boston, MA.


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.


Estrogen; Hormonal contraceptives; Migraine with aura; Migraine without aura; Progesterone; Stroke

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