This case study looks at the contraceptive choices for a woman who develops focal migraine on the combined oral contraceptive pill.
You see a 25 year-old female for a routine pill check. She has never smoked, her body mass index (BMI) is 24, and her blood pressure is 110/70 mm Hg. As part of your routine questioning you ask about any changes to her family history and medical history since her last check up. She comments on some infrequent but unusual headaches. It is obviously important to get some further details on these headaches, particularly to assess whether they are focal migraines.
Aims and objectives: This section covers whether the presence of focal migraine is important when considering other contraceptive methods.
Your patient has experienced right-sided facial ‘pins and needles’ before her headaches. You know that focal migraine contraindicates use of the COC pill due to the increased risk of stroke, but you are not sure about other methods.
>> WHO guidance on contraception for patients with focal migraine.
Aims and objectives: This section covers alternative methods of contraception for your patient with focal migraine.
She asks you what other methods of contraception are available to her. You explain that the non-hormonal IUD method offers the least risk of triggering her migraines. However, all the progesterone-only methods can also be used but, as these work hormonally, the risk is slightly increased. You give her a brief overview of POPs, contraceptive injections, contraceptive implants, the IUS and the IUD.
She has found that due to her new job, which involves shift work, she has been a little more forgetful with her pill taking so decides to go for a longer acting reversible method of contraception (LARC). Her main concerns are what her bleeding pattern will be like and what side effects she may experience.
>> LARC: the advantages, bleeding patterns and potential side effects.