4 Separate from the risk of unintended pregnancy, women who discontinue hormonal contraceptives due to headaches are unable to reap the noncontraceptive benefits of these medications, including relief of chronic pelvic pain, and selleck chem KPT-330 endometrial protection in polycystic ovary syndrome and other anovulatory states. This review outlines key differences among headache, migraine, and migraine with aura, and describes the strict diagnostic criteria. Society recommendations for hormonal contraception initiation and continuation in women with these diagnoses are emphasized. Finally, we provide information about the effect of hormonal fluctuations on headache, and recommendations regarding contraception counseling in patients who experience headache while taking hormonal contraception.

Diagnosis of a Headache Migraine Without Aura (Previously Known as Common or Simple Migraine) Migraine headache is distinguished from other headaches as a benign and recurring syndrome of headache, nausea, vomiting, and/or other symptoms of neurologic dysfunction. According to the American Migraine Prevalence and Prevention study, the 1-year prevalence of migraine in women is about 17.1%, and highest at 24.4% in reproductive-age women.5 The 1-year prevalence rate for migraine without aura, the common migraine, is 11% in women, making it the most frequent subset of migraine diagnoses.6 To make the diagnosis of migraine, neurologists follow the International Classification of Headache Disorders II (ICHD II) criteria, the official criteria of the International Headache Society (IHS).

7 Migraine With Aura (Previously Known as Complex Migraine) Migraine with aura has a 1-year prevalence rate of 5% in women.6 Aura specifically describes a complex of neurologic symptoms that occur just before or with the onset of migraine headache, and most often resolves completely before the onset of headache. Neurologists have long hypothesized that a phenomenon called cortical spreading depression (waves of altered brain function triggered by changes in cellular excitability) is responsible for migraine aura.8 Visual symptoms are the most common aura, and are a feature of 99% of auras.9 According to the ICHD II criteria, migraine with aura is a recurrent disorder manifesting in attacks of reversible focal neurologic symptoms that develop gradually over 5 to 20 minutes, and last for less than 60 minutes.

Headache with the features of migraine without aura usually follows the aura, although less commonly, the headache may lack migrainous features or be completely absent.7 The IHS Diagnostic Criteria for Migraine with Aura are depicted in Table 1. Table 1 The IHS Diagnostic Criteria for Migraine Risk of Stroke in Women With Migraines Migraine is an independent risk factor for ischemic Dacomitinib stroke.10�C19 However, the absolute risk of ischemic stroke is low in women of reproductive age, with reported incidence rates ranging from 5 to 11.