An evidence-based approach to hormonal contraception and headaches.

Some controversy exists regarding contraceptive management in women with migraines, particularly migraines with aura. The available scientific literature indicates that combined hormonal contraception is safe with most headache subtypes. However, it should be avoided in women with migraine with aura and women with simple migraines who have other risk factors for stroke. Progestin only contraceptives as well as the copper intrauterine device can be safely used in women with migraines. Accurate classification of a patient's headache type can avoid unnecessary restriction of effective contraceptive methods, particularly those containing estrogen.