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SUMMARY OF KEY ISSUESPrimary headache disorders such as migraine affect almost a third ofwomen during their child bearing years when decisions aboutcontraception must be made Headache is a commonly reported adverseevent in clinical trails of oral contraceptives1The important issues tobe considered in order to provide the 42 year old client with up to dateand relevant information should be split into two major areas Thefirst of these is eliciting additional details from the client in theconsultation to allow sharing of information and joint decision makingwhich will lead to an informed contraceptive choiceIt is important to explore the clients ideas concerns and expectationsare with regards to contraception and this consultation It is importantto discuss all the types of contraception for women above 40 years oldand the advantages and disadvantages of each method including efficacyrates and the benefits of long acting reversible contraception LARC inthis regard It is also important to discuss about the safety of COC inwomen above 40 years old and with migraine symptoms It is important toexplore more about her migraine symptoms headache any aura and itsrelation to menstrual cycles The second area includes important topics for literature review toprovide up to date information on the effects of contraception onheadache and migraine and also alternative migraine treatments TheseincludeIs there any evidence to suggest that COCP reduces or increasesmigraine symptomsDoes COCP increase stroke risk regardless of migraine statusDoes COCP increase stroke risk in women with migraineWhat is the current evidence with regards to non hormonal treatments ofmigraineWhat is the current evidence regarding the impact of estrogen dose onstroke risk and the impact of progesterone on stroke risk Are there any possible interactions between migraine treatments andcontraceptive options and other contraceptive options for women withmigraine LITERATURE REVIEWTo answer the above questions a literature review of the currentevidence was carried outThe following sources were usedThe Faculty of Sexual and Reproductive HealthcareFSRHRoyal College of Obstetricians and GynaecologistsRCOGNational Institute For Health and Clinical ExcellenceNICEThe United Kingdom Medical Eligibility
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