Contraceptive Options for Migraines with Aura

Contraindication of Combined Hormonal Contraceptives

Combined hormonal contraceptives (CHCs) containing estrogen are contraindicated in women with migraine with aura due to significantly increased risk of ischemic stroke 3, 4
Migraine with aura is an independent risk factor for stroke, and this risk is further amplified when combined with estrogen-containing contraceptives 1, 2
The American Heart Association/American Stroke Association explicitly recommends against using estrogen-containing contraceptives in individuals with migraine with aura 2

Progestin-only pills (POPs) containing norethindrone or drospirenone are safe options that do not increase stroke risk 1, 2
According to the 2024 AHA/ASA guidelines, progestin-only contraception carries no increased stroke risk, unlike estrogen-containing methods 2
POPs have demonstrated effectiveness with contraceptive success rates of <90% 1

Non-hormonal contraceptive methods that carry no stroke risk include barrier methods (condoms, diaphragm) 1, 2
Copper intrauterine device (IUD) is a non-hormonal option with no increased stroke risk 1, 2
Surgical sterilization (if permanent contraception is desired) is a non-hormonal option with no increased stroke risk 1, 2

Progestin-only methods may cause irregular bleeding patterns, which should be discussed with the patient 6
Regular follow-up is recommended to monitor changes in migraine pattern or frequency, and development of any new neurological symptoms 4

Contraceptive Method	Stroke Risk	Recommendation
Progestin-only pills	None	Strongly recommended [1, 2]
Progestin IUD	None	Strongly recommended [1, 2]
Progestin implant	None	Strongly recommended [1, 2]
Combined hormonal contraceptives	Increased	Contraindicated [1, 2]
Non-hormonal methods	None	Safe alternatives [1, 2]