Headache oral contraceptives

A 28-year-old healthy woman seeks your advice. She is about to leave on a 7-day Caribbean cruise and is concerned about motion sickness. She recently experienced nausea and one episode of vomiting while on a sailboat on Lake Michigan for an afternoon. She is not allergic to any medications. She does not smoke and only occasionally drinks alcohol. She takes an oral contraceptive (ethinyl estradiol and norgestimate) and occasional ibuprofen for headaches. 

Modafinil (Provigil) Analeptic Tab 100, 200 mg 200 mg qAM max 400 mg qAM. Nausea, headache. May reduce effectiveness of oral contraceptives. 

A 0.5% incidence of migraines has been reported among users of oral contraceptives. Migraine headaches may be a warning signal for an oncoming stroke, and immediate discontinuation of oral contraceptive use is recommended. 

These potential benefits are balanced by a slightly increased risk of gallbladder disease, hypertension, myocardial infarction, cerebral infarction, and pulmonary embolism. The increased risk of stroke and heart attack associated with the pill is accentuated when compounded by other risk factors, including smoking, migraine headaches, and advancing age. Indeed, convincing data support an upper age limit of 35 years for oral contraceptive use by women who smoke. 

Headache has long been reported as a reaction to oral contraceptives, just as it occurs unpredictably with many other forms of drug treatment it is probable that women... 

A systematic review of published data on the occurrence of headache with the more modest combination products now used has shown little indication that they have a clinically important effect on headache in most women (142). Headache that occurs during early cycles of oral contraceptive use tends to improve or disappear with continued use. No clear evidence supports the common clinical practice of switching from one oral contraceptive to another in the hope of attaining a lower incidence of headache. However, manipulating the extent or duration of estrogen withdrawal during the cycle may provide benefit. 

Loder EW, Buse DC, Golub JR. Headache as a side effect of combination estrogen-progestin oral contraceptives a systematic review. Am J Obstet Gynecol 2005 193 636-49. 

Contraindications Oral contraceptives are contraindicated in the presence of cerebrovascular and thromboembolic disease, estrogen-dependent neoplasms, liver disease, and migraine headache. 

Studies during the 1960s showing thatvitaminBg supplements were effective in overcoming some of the side effects of (high-dose) oral contraceptives have led to the use of vitamin Bg in treatment of the premenstrual syndrome - the condition of nervousness, irritability, emotional disturbance, headache, and/or depression suffered by many women for up to 10 days before menstruation. 

Doses of griseofulvin are 15-20 mg/kg/d for 6 to 8 weeks in children with the microsized form. More frequent side effects are minor headaches, gastrointestinal reactions and cutaneous eruptions. The major drug interactions have been noted with phenobarbital, anticoagulants and oral contraceptives. 

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