Are headaches a contraindication to the combined oral contraceptive pill (OCP)?
No. Some women with pre-existing headaches report improvement during oral contraceptive use. In other women “estrogen-withdrawal” migraine headaches occur during the pill-free week and continuous combined OCP use (skipping the pill-free week) or supplemental estrogen (e.g. a 100 ug estrogen patch) during the pill free week may be helpful. However migraines that are associated with an aura or neurological symptoms (complicated migraines) that occur on the combined OCP are worrisome and may warn of an impending cerebral ischemic event. Recent onset of severe headache or rapid worsening of a pre-existing headache pattern is an indication to discontinue combined OCP use and consider neurological consultation.
