. 2017 Oct 30;18(1):108.

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 Sacco¹, Gabriele S Merki-Feld², Karen Lehrmann Ægidius³, Johannes Bitzer⁴, Marianne Canonico⁵, Tobias Kurth⁶, Christian Lampl^{7

8}, Øjvind Lidegaard⁹, E Anne MacGregor^{10

11}, Antoinette MaassenVanDenBrink¹², Dimos-Dimitrios Mitsikostas¹³, Rossella Elena Nappi^{14

15}, George Ntaios¹⁶, Per Morten Sandset¹⁷, Paolo Martelletti^{18

19}; European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

Affiliations

¹ Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy. simona.sacco@univaq.it.
² Department of Gynecology, Clinic for Reproductive Endocrinology, University Hospital, Zürich, Switzerland.
³ Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark.
⁴ Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland.
⁵ Université Paris-Saclay, University Paris-Sud, UVSQ, CESP, Inserm UMRS1018, Orsay, France.
⁶ Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁷ Headache Medical Center Seilerstaette Linz, Linz, Austria.
⁸ Department of Geriatric Medicine Ordensklinikum Linz, Linz, Austria.
⁹ Department of Obstetrics & Gynaecology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁰ Centre for Neuroscience & Trauma, BICMS, Barts and the London School of Medicine and Dentistry, London, UK.
¹¹ Barts Sexual Health Centre, St Bartholomew's Hospital, London, UK.
¹² Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
¹³ Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹⁴ Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
¹⁵ University Consortium for Adaptive Disorders and Head Pain (UCADH), University of Pavia, Pavia, Italy.
¹⁶ Department of Medicine, University of Thessaly, Larissa, Greece.
¹⁷ Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway.
¹⁸ Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
¹⁹ Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy.

PMID: 29086160
PMCID: PMC5662520
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 et al. J Headache Pain. 2017.

. 2017 Oct 30;18(1):108.

doi: 10.1186/s10194-017-0815-1.

Authors

Affiliations

¹ Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy. simona.sacco@univaq.it.
² Department of Gynecology, Clinic for Reproductive Endocrinology, University Hospital, Zürich, Switzerland.
³ Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark.
⁴ Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland.
⁵ Université Paris-Saclay, University Paris-Sud, UVSQ, CESP, Inserm UMRS1018, Orsay, France.
⁶ Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁷ Headache Medical Center Seilerstaette Linz, Linz, Austria.
⁸ Department of Geriatric Medicine Ordensklinikum Linz, Linz, Austria.
⁹ Department of Obstetrics & Gynaecology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁰ Centre for Neuroscience & Trauma, BICMS, Barts and the London School of Medicine and Dentistry, London, UK.
¹¹ Barts Sexual Health Centre, St Bartholomew's Hospital, London, UK.
¹² Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
¹³ Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹⁴ Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
¹⁵ University Consortium for Adaptive Disorders and Head Pain (UCADH), University of Pavia, Pavia, Italy.
¹⁶ Department of Medicine, University of Thessaly, Larissa, Greece.
¹⁷ Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway.
¹⁸ Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
¹⁹ Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy.

PMID: 29086160
PMCID: PMC5662520
DOI: 10.1186/s10194-017-0815-1

Erratum in

Correction to: 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 S, Merki-Feld GS, Ægidius KL, Bitzer J, Canonico M, Kurth T, Lampl C, Lidegaard Ø, Anne MacGregor E, MaassenVanDenBrink A, Mitsikostas DD, Nappi RE, Ntaios G, Sandset PM, Martelletti P; European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). Sacco S, et al. J Headache Pain. 2018 Sep 10;19(1):81. doi: 10.1186/s10194-018-0912-9. J Headache Pain. 2018. PMID: 30203397 Free PMC article.

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.

Keywords: Aura; Contraception; Headache; Hormonal contraceptives; Migraine; Stroke.

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Conflict of interest statement

Simona Sacco received grants for lectures and as member of advisory board from Allergan and Bayer HealthCare.

Gabriele S Merki-Feld received grants for lecturers, as member of advisory boards and/or consultant from Bayer HealthCare, HRA Pharma, MSD and Teva.

Karen Lehrmann Ægidius reports no competing interests.

Johannes Bitzer received grants as for lectures and as member of advisory boardfrom Bayer HealthCare, Merck, Gedeon Richter, Böhringer Ingelheim, Lilly, Actavis, Allergan, Menarini, Mithra, Exeltis, Janssen, Teva.

Marianne Canonico reports no competing interests.

Tobias Kurth has received investigator-initiated research funding from the French National Research Agency, the US National Institutes of Health, the German Ministry of Research and Education, and the Else-Kröner-Frisenius Stiftung. Further, he has received honoraria from Novartis for educational lectures and from the BMJ and Cephalalgia for editorial services; he further received travel compensation from the International Headache Society and the American Headache Society. For scientific methodological advice of Dr. Kurth, the Charité – Universitätsmedizin Berlin has received unrestricted funds from CoLucid and Allergan.

Christian Lampl reports no competing interests.

Øjvind Lidegaard reports no competing interests.

E Anne MacGregor received grants for consultancy fees and educational meetings from Consilient Health and Bayer HealthCare.

Antoinette Maassen VanDen Brink received grants for lectures, as member of advisory boards and/or consultant from Amgen, ATI, CoLucid, Lilly, and Novartis.

Dimos-Dimitrios Mitsikostas received grants for research, honoraria or consulting fees from Allergan, Amgen, Biogen, Brain Therapeutics, Cefaly Technology, Genesis Pharma, ElectroCore, Eli Lilly, Novartis, Roche, Sanofi-Genzyme, and Teva.

Rossella Elena Nappi received grants for lectures, as member of advisory boards and/or consultant from Bayer HealthCare, Endoceutics, Gedeon Richter, HRA Pharma, MSD, Novo Nordisk, Pfizer, Shionogi and Teva.

George Ntaios received grants for lectures, as member of advisory board or as research support from Amgen, Bayer HealthCare, Boehringer-Ingelheim, BMS/Pfizer, Elpen, Galenica, Medtronic, Sanofi, Winmedica.

Per Morten Sandset reports no competing interests.

Paolo Martelletti received grants for lectures, conferences and education from ACRAF, Allergan, Amgen, ElectroCore, Elytra Pharma, Novartis, Sanofi, Teva.

Figures

**Fig. 1**
Flow-chart for the systematic review

See this image and copyright information in PMC

References

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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)

Affiliations

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)

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

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References

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Full Text Sources

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Medical

Research Materials

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