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Migraine with aura contraception — DRCOG MCQ

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HardContraception and Sexual HealthMigraine with aura contraceptionDRCOG

A 28-year-old woman requests the combined pill. She has migraine with visual aura twice a year, BMI 24 kg/m² and does not smoke. Blood pressure is 118/70 mmHg. What would you advise?

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Correct answer: C — Offer a POP, implant, intrauterine or barrier method instead

The best answer is “Offer a POP, implant, intrauterine or barrier method instead”. Migraine with aura is a contraindication to combined hormonal contraception because of increased ischaemic stroke risk. The absence of smoking or hypertension does not make CHC suitable. The pearl is that aura history matters more than migraine frequency when assessing CHC eligibility. UK prevention and management depend on the exact risk profile and gestation. High-risk patients, or those with more than one moderate-risk factor, should take prescribed aspirin 75–150 mg daily from 12 weeks until birth. Severe symptoms or postpartum hypertension require urgent assessment because pre-eclampsia can first present or deteriorate after delivery.

Reference: NICE NG133: Hypertension in pregnancy: https://www.nice.org.uk/guidance/ng133/chapter/recommendations