Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

Simona Sacco; Gabriele S Merki-Feld; Karen Lehrmann Ægidius; Johannes Bitzer; Marianne Canonico; Tobias Kurth; Christian Lampl; Øjvind Lidegaard; E Anne MacGregor; Antoinette MaassenVanDenBrink; Dimos-Dimitrios Mitsikostas; Rossella Elena Nappi; George Ntaios; Per Morten Sandset; Paolo Martelletti; European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

doi:10.1186/s10194-017-0815-1

Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

Simona Sacco, Gabriele S Merki-Feld, Karen Lehrmann Ægidius, Johannes Bitzer, Marianne Canonico, Tobias Kurth, Christian Lampl, Øjvind Lidegaard, E Anne MacGregor, Antoinette MaassenVanDenBrink, Dimos-Dimitrios Mitsikostas, Rossella Elena Nappi, George Ntaios, Per Morten Sandset, Paolo Martelletti, European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

Department of Clinical Medicine

63 Citations (Scopus)

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Abstract

Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face the issue of migraine and hormonal contraceptive use in clinical practice. In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. Thereafter a consensus procedure among international experts was done to develop statements to support clinical decision making, in terms of cardiovascular safety, for prescription of hormonal contraceptives to women with migraine. Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura. Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. As the quality of available data is poor further research is needed on this topic to increase safe use of hormonal contraceptives in women with migraine.

Original language	English
Article number	108
Journal	Journal of Headache and Pain
Volume	18
Number of pages	20
ISSN	1129-2369
DOIs	https://doi.org/10.1186/s10194-017-0815-1
Publication status	Published - 1 Dec 2017

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Sacco, S., Merki-Feld, G. S., Ægidius, K. L., Bitzer, J., Canonico, M., Kurth, T., Lampl, C., Lidegaard, Ø., Anne MacGregor, E., MaassenVanDenBrink, A., Mitsikostas, D.-D., Nappi, R. E., Ntaios, G., Sandset, P. M., Martelletti, P., & European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC) (2017). Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). Journal of Headache and Pain, 18, Article 108. https://doi.org/10.1186/s10194-017-0815-1

Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). / Sacco, Simona; Merki-Feld, Gabriele S; Ægidius, Karen Lehrmann et al.
In: Journal of Headache and Pain, Vol. 18, 108, 01.12.2017.

Research output: Contribution to journal › Journal article › Research › peer-review

Sacco, S, Merki-Feld, GS, Ægidius, KL, Bitzer, J, Canonico, M, Kurth, T, Lampl, C, Lidegaard, Ø, Anne MacGregor, E, MaassenVanDenBrink, A, Mitsikostas, D-D, Nappi, RE, Ntaios, G, Sandset, PM, Martelletti, P & European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC) 2017, 'Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)', Journal of Headache and Pain, vol. 18, 108. https://doi.org/10.1186/s10194-017-0815-1

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abstract = "Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face the issue of migraine and hormonal contraceptive use in clinical practice. In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. Thereafter a consensus procedure among international experts was done to develop statements to support clinical decision making, in terms of cardiovascular safety, for prescription of hormonal contraceptives to women with migraine. Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura. Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. As the quality of available data is poor further research is needed on this topic to increase safe use of hormonal contraceptives in women with migraine.",

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AU - Merki-Feld, Gabriele S

AU - Ægidius, Karen Lehrmann

AU - Bitzer, Johannes

AU - Canonico, Marianne

AU - Kurth, Tobias

AU - Lampl, Christian

AU - Lidegaard, Øjvind

AU - Anne MacGregor, E

AU - MaassenVanDenBrink, Antoinette

AU - Mitsikostas, Dimos-Dimitrios

AU - Nappi, Rossella Elena

AU - Ntaios, George

AU - Sandset, Per Morten

AU - Martelletti, Paolo

AU - European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

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N2 - Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face the issue of migraine and hormonal contraceptive use in clinical practice. In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. Thereafter a consensus procedure among international experts was done to develop statements to support clinical decision making, in terms of cardiovascular safety, for prescription of hormonal contraceptives to women with migraine. Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura. Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. As the quality of available data is poor further research is needed on this topic to increase safe use of hormonal contraceptives in women with migraine.

AB - Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face the issue of migraine and hormonal contraceptive use in clinical practice. In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. Thereafter a consensus procedure among international experts was done to develop statements to support clinical decision making, in terms of cardiovascular safety, for prescription of hormonal contraceptives to women with migraine. Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura. Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. As the quality of available data is poor further research is needed on this topic to increase safe use of hormonal contraceptives in women with migraine.

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