Question of the Week #116

116) A 26 year old woman has dysmenorrhea that has not responded to treatment with NSAIDs. Her past medical history is significant for migraine without aura and takes  Topiramate  for prevention of migraine. Her migraines are well prevented now. She is also sexually active and requests contraception. In view of her dysmenorrhea, OC pills have been recommended to her as it serves to address both the issues of contraception as well as her dysmenorrhea. But she tells you that she once read the package insert in the OC pills and also heard from her friends that she should not use OCPs because she has migraine. Her exam does not reveal any neurological deficits. She does not smoke and leads an active lifestyle. Her B.P  is 110/70. What is your best recommendation to her?
A. Reassure her and start OC Pills
B. Tell her to use condoms alone
C. Start minipill because OC pills may worsen her headache
D. Start OC pills but switch topiramate to valproic acid to prevent her migraines bette

9 Responses

  1. A

  2. start minipill

  3. i just read the recommendations:Most women with migraine without aura can safely take estrogen containing OCPs if they do not smoke, are less than 35 years old, and are normotensive. according to it,A is the answer

  4. a…..only migraine with aura….relative C/i for OCP

  5. Reassure her and start the OCP’s because topiramate is controlling her migraines. If she had migraines at present which were uncontrolled then you would the extended OCP and see the response. Moreover, no smoking, no aura, no CNS problems so there’s no risk of thrombo-embolism!

    Answer A

  6. Start OCP as it is migraine without aura but start OCP which has low dose of estrogen

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