Relationship of migraine headache and stroke to oral contraceptive use
Benson, M.D.; Rebar, R.W.
Journal of Reproductive Medicine 31(12): 1082-1088
1986
ISSN/ISBN: 0024-7758 PMID: 3540297 Document Number: 280841
Three studies directly evaluated the effects of oral contraceptive (OC) use on migraine headache frequency. The Walnut Creek Study in 1980 was unable to demonstrate a higher frequency of migraine headache in OC users discharged from the hospital as compared with nonusers. Another study in 1978 evaluated the effect of 0.5 mg of norgestrel and 50 mcg of ethinyl estradiol (Ovral) on 40 migraine sufferers. 20 patients received this preparation for the first 2 months of the study, the other 20 did not. 29 patients experienced worsening of their headaches with OC use. However, one-third of the patients did note improvement in their headaches. A third study in 1976 of women suffering from migraine suggested that about one-third of women noted worsening of their headaches while taking OCs. The risks of cerebrovascular accident (CVA) include advancing age, smoking, and the use of high-dose pills. Increase in blood pressure, platelet aggregatability, and cholesterol deposition are the three known mechanisms of the risk of stroke. No blind study of the subject has even been made, and a significant minority of OC users reported improvements in their migraine headaches. Circumstantial evidence suggests that there is an increased risk of stroke in OC users, although these case control studies differed with regard to the degree of relative risk. Two of three cohort studies were unable to demonstrate the increased risk of CVA among these women. The absolute risk of thrombotic stroke remains small for OC users, and the absolute risk is probably very small even for those taking OCs. However, the risk of hemorrhagic stroke may increase fivefold in those smoking. For nonsmokers, OC use is probably safer in all age groups than no contraception. A 1977 study showed that 40-44 year old nonsmokers taking OCs had an estimated death rate of 7/100,000. In contrast, those who used no method of contraception had a higher mortality rate of 23/100,000.