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
My ans is C.
Eventhough her migrain is well controlled with drugs, she still have high risk of stroke, so minipill is safe.
But Q is..
C. Start minipill because OC pills may worsen her headache...? Are u agree?
*A woman with a history of migraine has a 4 fold increase in her risk of stroke compared to her peer who does not have migraines, or 16 to 20 strokes per 100,000 women with migraine per year.
�� If the same woman with migraines uses a low-dose estrogen-containing birth control method, her risk for stroke is increased by 7 fold to 28 to 35 strokes per 100,000 women with migraines who use low-dow estrogen-containing birth control pills per year.
�� The woman who has migraines, uses an estrogen-containing birth control method, and smokes has a 34 fold increase in her risk of stroke, or 134 to 170 strokes per 100,000 smokers with migraines on birth control pills per year.
For the above reasons, it is strongly recommended that women with a personal or family history of migraine headaches should select non-estrogen methods of contraception. Ask your health care providers about the alternative options.
A and C are both possibility , I will pick A
careful f/u is recommended. i believe patients should be monitored for a change in frequency or severity of headache, and for the development of a change in pattern of headache, such as development of aura with headache. If these occur, d/c of the OCP would be done.
c will not help her dysmenorrhea
This is a case of common migraine ( no aura ) and is under control,
so I will go with ocpills, if the migraine gets worse then I will pick the other possiblity.
A
mini pills are progesterone only birth control pills. They will not help with the dysmenorrhea.
Except for migraine she has no other risk factors for stroke.
The Q is from Dr.Red gynecology lectures.
The answer is A.
Explanation:
A. This patient has migraine without aura, no focal neurological deficits and no additional risk factors for stroke. So, it is recommended to start OC pills as benefits outweigh risks in her case ( i.e; OC pills will improve her dysmenorrhea).
Several studies have shown that headache occurring in association with OC use tended to improve despite continued OC use. OC pills are contraindicated only if migraines are associated with aura or neurological deficits or if the patient has additional risk factors for a stroke other than OC pill use alone.
Choice B is incorrect. Condom use is not superior to OC pills in regards to providing effective contraception. This modality also does not benefit her dysmenorrhea.
Choice C is incorrect. Progesterone only pill will not benefit her dysmenorrhea
Choice D is incorrect. Patient's migraine is well controlled on Topiramate. In this setting, switching to another agent in the absence of contraindications or adverse effects is inappropriate.