Choosing Contraception for Women With Migraine

What are the current recommendations for hormonal contraception (eg, oral contraceptives, medroxyprogesterone( injections) in patients with migraine?
—Joanne E. Steane, MD
  Laramie, Wyo
Most physicians avoid prescribing oral contraceptives that contain estrogen for women whose migraines are accompanied by neurologic symptoms, such as weakness or numbness. Some clinicians are also hesitant to use combination agents in patients with significant aura.
Several years ago, there was concern that the high level of estrogen in oral contraceptives might cause vascular complications. However, current combination drugs have a much lower level of estrogen. Nonetheless, if a woman who has migraine with aura takes oral contraceptives, other risk factors-such as smoking or high blood pressure-need to be controlled.
I am unaware of any strong data on the effects of progesterone( in women with migraine; however, I do not think medroxyprogesterone injections are contraindicated in this setting.
—Robert Kunkel, MD
  Headache Center
  Department of Neurology
  The Cleveland Clinic Foundation