migraine and the combined oral contraceptive pill

FREE subscriptions for doctors and students... click here
You have 3 more open access pages.

Patients should be warned to report increase in headache frequency or onset of focal symptoms - the combined pill should be discontinued and the patient urgently referred if focal neurological symptoms not typical of aura persist for 1 hour or more.

The combined pill is contra-indicated in:

  • patients who suffer regular severe migraines lasting more than 72 hours despite treatment
  • patients who suffer migraines with typical focal aura
  • in patients with migraines without aura if there more than one additional risk factor for arterial disease (1)
  • if migraine is treated with ergot derivatives

The combined pill can be prescribed with caution in patients who:

  • have migraines without typical focal aura

UKMEC Criteria state:

In consideration of UKMEC criteria and combined hormonal contraception (CHC):

Cardiovascular factors (including migraine) and UKMEC categories (3):

 

Check the summary of product characteristics before prescribing any combined oral contraceptive pill.

Reference:

  • (1) DTB (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 06/2020

Links: