hypertension and combined oral contraceptive (COC) pill as a risk factor for cardiovascular disease
- a combined pill containing a low dose of oestrogen (i.e. 30 mcg) is indicated
in women who have migraines without auras - this is because the risk of stroke
is greater the higher the dose of oestrogen in the combined pill
- a DTB review (1) suggested that low-dose pill can also be given to women
who have migraines without auras but have one additional risk factor for stroke
- however the review emphasises that these patients must be followed up carefully
- prescribing decisions, with respect to combined hormonal contraception, are made based on the UKMEC criteria below which define migraine with an aura as an absolute contraindication to combined hormonal contraception - see below for further details and guidance with respect to different migraine scenarios
UKMEC Criteria state:
Cardiovascular factors (including migraine) and UKMEC categories (3):
In consideration of UKMEC criteria and combined hormonal contraception (CHC):
Check the summary of product characteristics before prescribing any combined oral contraceptive pill.
- (1) Drug and Therapeutics Bulletin (2000), 38 (1), 1-4.
- (2) BNF 7.3
- (3) FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended July 2019)
Last edited 06/2020 and last reviewed 05/2021