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Contraception with migraine with aura — GPhC CRA MCQ

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ModeratePatient Counselling and Pharmaceutical CareContraception with migraine with auraGPhC CRA

A 36-year-old woman with a history of migraine with aura asks to restart a combined oral contraceptive she used years ago. She smokes five cigarettes daily and takes sumatriptan when needed. She requests a supply through a pharmacy contraception service. What is the most appropriate alternative?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Offer or refer for a progestogen contraceptive option if suitable

Migraine with aura is a contraindication to combined hormonal contraception because of stroke risk. Smoking adds cardiovascular risk, but the aura history alone is sufficient to avoid combined hormonal contraception. Progestogen-only methods may be suitable after assessment under the service specification.

Reference: FSRH guidance; BNF