Combined Hormonal Contraceptive not tied to significant stroke risk in Migraine with Aura

New research revealed that combined hormonal contraceptives (CHC) can be used by migraine patients as the overall stroke risk has reduced. The risk was lower in patients with migraine with aura than those without aura. The study was published in the journal Headache. 

Women of reproductive age, despite migraines, need an effective form of contraception. Migraine is a common headache disorder affecting women more than men. Some of the guidelines discourage the use of combined hormonal contraceptives in women due to the risk of stroke. This leads to non-adherence and non-alignment to contraceptive methods. As there were limited data and uncertainty on the factors affecting estrogen with a history of migraine and the impact of ischemic stroke risks associated with combined hormonal contraceptive (CHC) use researchers conducted a case-control analysis to study the CHC use in those with migraine with aura in a large tertiary care center. 

The analysis included women aged 18–55 who used a CHC between January 1, 2010, and December 31, 2019. Patients with stroke diagnoses were identified using ICD codes and confirmed via chart and imaging review. Other details like the personal and family medical history, stroke evaluation, ethinyl estradiol dosing (EE; ≥30 vs. <30 μg), and demographics were collected. About 635 control cohorts could be identified from a random sample of 20,000 CHC users without stroke and matched based on patient characteristics, medical and family histories, and stroke risk factors to assess the association between migraine diagnosis, migraine subtype, estrogen dose, and stroke.