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Migraine with Aura – CHC Contraindicated — SCE Neurology MCQ

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HardHeadache & Facial PainMigraine with Aura – CHC ContraindicatedSCE Neurology

A 29-year-old with recurrent migraine with visual aura requests combined hormonal contraception. She does not smoke and has normal blood pressure. What advice is correct?

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Correct answer: A — Avoid combined hormonal contraception because migraine with aura is UKMEC category 4; discuss suitable non-oestrogen alternatives

The best answer is “Avoid combined hormonal contraception because migraine with aura is UKMEC category 4; discuss suitable non-oestrogen alternatives”. Migraine with aura makes combined hormonal contraception an unacceptable health risk irrespective of smoking status; effective progestogen-only and non-hormonal options remain. “Use any combined hormonal method without restriction” is plausible in a different neurological context, but the decisive findings here argue against it. “Use combined hormones only with prophylactic aspirin” is plausible in a different neurological context, but the decisive findings here argue against it. “Use a lower oestrogen dose because that removes stroke risk” is plausible in a different neurological context, but the decisive findings here argue against it. “Restrict combined hormones only when aura lasts longer than one hour” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: UKMEC 2016: medical eligibility criteria for contraceptive use: https://www.fsrh.org/standards-and-guidance/fsrh-guideline-ukmec/