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Considerations for Contraceptive Use Among Patients with Migraines
AbstractPurpose of ReviewThere is an overlap in the populations of patients who suffer from migraine headaches and patients who seek contraception. The purpose of this review is to present recent studies on contraception among patients with migraines and provide clinical recommendations.Recent FindingsMigraine with aura and combined hormonal contraceptive (CHC) use are associated with increased ischemic stroke risk. The use of CHCs in patients with migraine with aura produces a higher risk of ischemic stroke than either factor individually; therefore, CHC is contraindicated in this population by certain guidelines. However...
Source: Current Obstetrics and Gynecology Reports - March 2, 2023 Category: OBGYN Source Type: research

Pregnancy-Related Stroke: A Review
Conclusions and Relevance Early recognition and management are integral in decreasing the morbidity and mortality associated with a stroke in pregnancy. Relevance Statement This study was an evidence-based review of stroke in pregnancy and how to diagnose and mange a pregnancy complicated by a stroke. Target Audience Obstetricians and gynecologist, family physicians Learning Objectives After completing this learning activity, the participant should be better able to identify the pregnancy-related risk factors for a stroke; explain the presenting signs and symptoms of a stroke in pregnancy; describe...
Source: Obstetrical and Gynecological Survey - June 1, 2022 Category: OBGYN Tags: CME ARTICLES Source Type: research

Migraine and menopause - a narrative review
Discussion and conclusion: Many women are informed that their migraines will disappear postmenopause; there are some data to support this, but a specific time frame has not been evidenced. Stroke risk in women with migraine with aura is small in absolute terms, but important at the population level, because migraine is so prevalent. The risk becomes clinically important in the context of additional stroke risk factors, which increase with aging such as hypertension. Estrogen in combined hormonal contraception increases the risk of an ischemic stroke, however, the lower amount of estrogen in HT may not contribute to a m...
Source: Menopause - January 1, 2021 Category: OBGYN Tags: Review Articles Source Type: research

The severity of vasomotor symptoms and number of menopausal symptoms in postmenopausal women and select clinical health outcomes in the Women's Health Initiative Calcium and Vitamin D randomized clinical trial
This study evaluated whether vasomotor symptom (VMS) severity and number of moderate/severe menopausal symptoms (nMS) were associated with health outcomes, and whether calcium and vitamin D (CaD) modified the risks. Methods: The Women's Health Initiative CaD study was a double blind, randomized, placebo-controlled trial, which tested 400 IU of 25-hydroxyvitamin-D and 1,000 mg of calcium per day in women aged 50 to 79 years. This study included 20,050 women (median follow-up of 7 y). The outcomes included hip fracture, colorectal cancer, invasive breast cancer, all-cause mortality, coronary heart disease, stroke, cardi...
Source: Menopause - October 30, 2020 Category: OBGYN Tags: Original Studies Source Type: research

142: Migraines in pregnancy and select adverse pregnancy outcomes
The objective of this study was to assess risk factors associated with maternal migraine, and the risk of maternal stroke, postpartum hemorrhage, and preterm birth in a large California birth cohort.
Source: American Journal of Obstetrics and Gynecology - December 31, 2019 Category: OBGYN Authors: Gretchen Bandoli, Rebecca J. Baer, Laura L. Jelliffe-Pawlowski, Christina Chambers Tags: Poster Session I Source Type: research

Combined hormonal contraception and migraine: are we being too strict?
Purpose of review Combined hormonal contraception has been contraindicated in migraines, especially in migraines with aura, because of ischemic stroke risk. Newer formulations are now available and physicians may unnecessarily be limiting access to contraceptive and medical therapeutic options for patients with migraines. This review summarizes the available data regarding ischemic stroke risk of modern combined hormonal contraception in the setting of migraines. Recent findings Limited data exists on current formulations of combined hormonal contraception and outcomes in migraine patients. Studies indicate ischemic s...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Review of Migraine Incidence and Management in Obstetrics and Gynaecology
ConclusionMigraines have a high incidence in gynaecology and obstetrics. Health care providers must include screening questions when history taking to identify women with migraines and effectively manage them. Proper follow-up and treatment is required for all women with migraines in order to minimize the risk of cerebrovascular events, and negative pregnancy outcomes. Women with migraines are advised to avoid combined hormonal contraception and use progesterone only pills.
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - July 18, 2019 Category: OBGYN Source Type: research

Systolic Hypertension, Preeclampsia-Related Mortality, and Stroke in California.
CONCLUSION: Stroke is the major cause of maternal mortality associated with preeclampsia or eclampsia. All but one patient in this series of strokes demonstrated severe elevation of systolic blood pressure, whereas other variables were less consistently observed. Antihypertensive treatment was not implemented in the majority of cases. Opportunities for care improvement exist and may significantly affect maternal mortality. PMID: 31135728 [PubMed - in process]
Source: Obstetrics and Gynecology - May 29, 2019 Category: OBGYN Authors: Judy AE, McCain CL, Lawton ES, Morton CH, Main EK, Druzin ML Tags: Obstet Gynecol Source Type: research

Neurological diseases in pregnancy
Purpose of review To summarize recent research findings and current concepts related to care of neurologic diseases in pregnancy and the risks of pregnancy to the mother–infant dyad. Recent publications related to best practices for neurologic care, risks of pregnancy, rate of relapse during and after pregnancy, as well as medication safety in pregnancy and lactation for more commonly used neurologic medications are reviewed. Recent findings Data continues to grow that women with neurologic conditions can experience pregnancy with minimal risks. Additionally, as more data is being published on medication safety in p...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Diagnosing causes of headache within the postpartum period.
CONCLUSIONS: Research has shown that many postpartum headaches go undiagnosed and as a result are poorly treated, often returning following discharge from secondary care (Nelson-Piercy 2010 ). The hope is that the introduction of this adjuvant will allow clinicians to identify the cause of postpartum headaches earlier and will allow life threatening diagnoses to be quickly excluded. PMID: 29944052 [PubMed - in process]
Source: Journal of Obstetrics and Gynaecology - June 28, 2018 Category: OBGYN Tags: J Obstet Gynaecol Source Type: research

Reply
We thank Drs Driul and Londero for their interest in our study.1 We agree that thrombogenic mutations may be a contributing factor in migraine-related stroke. We did not adjust for known thrombogenic mutations; however, because combined hormonal contraceptives (CHCs) are not recommended for use by women with known thrombogenic mutations because of safety concerns,2 we expect that there would be only a small number of women with those disorders who use CHCs. Our analysis adjusted for the important confounders mentioned by Drs Driul and Londero, namely age, hypertension, smoking, and obesity as well as others that included d...
Source: American Journal of Obstetrics and Gynecology - November 23, 2017 Category: OBGYN Authors: Naomi K. Tepper, Kathryn M. Curtis, Steven W. Champaloux Tags: Letter to the Editors Source Type: research

Migraine with aura and screening for biological  thrombophilia
We read with interest the article of Champaloux et  al1: “Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke.” We believe that the study limitations do not sufficiently highlight the lack of adjustment for thrombophilia in the analysis as a limitation.
Source: American Journal of Obstetrics and Gynecology - November 23, 2017 Category: OBGYN Authors: Driul Lorenza, A.P. Londero Tags: Letter to the Editors Source Type: research

Use of Combined Hormonal Contraceptives Among Women With Migraines and Risk of Ischemic Stroke
(Abstracted from Am J Obstet Gynecol 2017;216:489.e1–489.e7) Migraine headaches occur commonly in women; more than 40% will have a migraine during their lifetime. Women of reproductive age who experience migraine, especially those with aura are at increased risk of ischemic stroke.
Source: Obstetrical and Gynecological Survey - September 1, 2017 Category: OBGYN Tags: Gynecology: Contraception Source Type: research

Neurological Disease in Women: Stroke, Cognition, and Headache
Journal of Women's Health , Vol. 0, No. 0.
Source: Journal of Women - April 7, 2017 Category: OBGYN Source Type: research

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