True migraine headaches are any more common in women, while tension headaches occur equally in men and women. There have been no well-done studies to determine the impact of oral contraception on migraine headaches. Patients may report that their headaches are worse or better.

Studies with high dose pills indicated that migraine headaches were linked to a risk of stroke. There is reason to believe that the combination of good patient screening and the use of little dose oral contraception has virtually eliminated the risk of stroke. Nevertheless, because of the seriousness of this potential complication, the onset of visual symptoms or severe headaches requires a serious response. Certainly if the patient is at a higher dose, a move to a little dose formulation often relieves the symptom. Switching to a different brand is worthwhile, if only to evoke a placebo response. True vascular headaches are an indication to discontinue oral contraception.

Clues to severe vascular headaches:

¢?÷ Headaches that last a long time.
¢?÷ Dizziness, nausea, or vomiting with headaches.
¢?÷ Scotomata or blurred vision.
¢?÷ Episodes of blindness.
¢?÷ Unilateral, unremitting headaches.
¢?÷ Headaches that continue despite medication.

In some women, a relationship exists between their fluctuating hormone levels during a menstrual cycle and migraine headaches, with the onset of headaches characteristically coinciding with menses. We have had personal success (anecdotal to be sure) alleviating headaches by eliminating the menstrual cycle, either with the use of daily oral contraceptives or the daily administration of a progestational agent (such as 10 mg medroxyprogesterone acetate). Some women with migraine headaches have extremely gratifying responses.