Several data indicate that migraine, especially migraine with aura, is
associated with an increased risk of ischemic stroke and other vascular
events. Of concern is whether the risk of ischemic stroke in migraineurs is
magnified by the use of hormonal contraceptives. As migraine prevalence is
high in women of reproductive age, it is common to face the issue of migraine
and hormonal contraceptive use in clinical practice. In this document, we
systematically reviewed data about the association between migraine, ischemic
stroke and hormonal contraceptive use. Thereafter a consensus procedure among
international experts was done to develop statements to support clinical
decision making, in terms of cardiovascular safety, for prescription of
hormonal contraceptives to women with migraine. Overall, quality of current
evidence regarding the risk of ischemic stroke in migraineurs associated with
the use of hormonal contraceptives is low. Available data suggest that
combined hormonal contraceptive may further increase the risk of ischemic
stroke in those who have migraine, specifically migraine with aura. Thus, our
current statements privilege safety and provide several suggestions to try to
avoid possible risks. As the quality of available data is poor further
research is needed on this topic to increase safe use of hormonal
contraceptives in women with migraine