2/10/2024 0 Comments Spironolactone migraine with aura![]() Disagreements were resolved by consensus. Full texts of selected studies were evaluated when appropriate. Two investigators from the statement Supporting Group (FP and RO) independently screened the titles and abstracts of the publications identified to verify study eligibility. Both observational (cross-sectional, case-control, and cohort) and intervention studies (RCTs) were included. The following search terms were used in both databases: “migraine” AND (contraceptive OR estrogen) AND (vascular OR stroke OR “myocardial infarction” OR angina OR “coronary artery disease” OR “coronary heart disease” OR “venous thrombosis”). An initial literature search included all papers indexed on PubMed and Scopus, from inception to August 30, 2016. Hence, the aim of the present paper is to systematically review the association between migraine, ischemic stroke and HC use and to develop a consensus among international experts to support clinical decision-making in terms of cardiovascular safety for prescription by healthcare professionals of HCs to women with migraine.Ī systematic search of the literature was conducted to identify key papers addressing the association between migraine and cardiovascular events in women using HCs. As migraine prevalence is high in women of reproductive age it is common to face the issue of migraine and HC use in clinical practice. Whether the risk of ischemic stroke in women with migraine is magnified by use of combined hormonal contraceptives (HCs) is unclear. Two meta-analyses did not demonstrate an association between migraine without aura and ischemic stroke. Further, the definition of a clear association between migraine without aura and ischemic stroke is even more complex as some studies did not include information on migraine aura and because of the challenge of aura diagnosis in epidemiological studies. For migraine without aura, the interpretation of available data is more complex as some studies reported that migraine without aura is also associated with an increased risk of ischemic stroke whereas in others the association was not confirmed. Most of the evidence supports an increased risk of ischemic stroke associated with migraine with aura. Several case-control and cohort studies, as well as pooled data analyses, indicate that migraine is a risk factor for stroke and other vascular events. 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. Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura. Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. 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. In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. 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. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events.
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