118) A 30-year-old woman has been using oral contraceptive pillls, combination type for past 8 yrs. However, she also has a history of migraines. Lately, she has been experiencing an average of 14 episodes of severe migraine without aura yearly. Careful evaluation of her headache calender reveals that most of them occur exclusively during the pill-free week of her OC regimen. She has no history of smoking. She has never had DVT or family hx of thrombophilia. Her physical exam is normal without any neurological deficits. Next step in management ?
A. Switch to low dose estrogen pills
B. Switch to minipill
C. Discontinue OC pills
D. Start extended duration OC pills like seasonale
B
B
D
Dr Red please tell the answer.
Thanks
D
D
can someone clarify? if someone is <35 and no history of aura, then they can continue low dose of the same medication
A)Switch to low dose estrogen pill
Approach-21 days OCP(Combined)+Start low dose estrogen
approach 2-Take OCP(Combined) for 28 days for 3-6 months
switch to minipill,
its progesteron which is causing the problem so either we need to discontinue pills or start low dose estrogen in drug free period but if we do so how patient is going to have breakthrough bleeding
so the best is stop ocp and advise for iucd
so c is best answer
need answer from dr red
d) because all the episodes of migraine are in the pill free days that means OCP is helping the migraine in this case..
Headaches are frequently cited for women to discontinue OCP’s, but there is no strong correlation of headaches and OCP’s and there is no evidence that the type of progestin or amount of estrogen will alter headaches, except in women with menstrual migraines! Among migraines, headache may improve, worsen or remain unchanged.
There’s a catch though– There’s an increased risk of cerebral thromboembolism in women with a history of pseudotumor cerebri or migraines with AURA, neurological problems, here OCP’S will be contraindicated for SURE!
This patient does not have an aura, so we would see her response to the OCP’s which would be extended duration OCP’s. If it worsens, then you will stop the OCP. If it improves, continue, if it has no effect, continue!
Peace,
Mufy