Add birth control pills (OCPs for oral contraceptive pills) and that number doubles to 9, presumably due to the estrogen component of OCPs. Add migraines with aura, and now we're talking 50 to 60 strokes per 100,000 women per year. Add cigarette smoking and age over 35 and the number skyrockets.
Migraines are severe, disabling, usually but not always one-side headaches, usually associated with other neurologic symptoms. An aura is the presence of these symptoms (usually visual disturbances) just before the onset of the headache.
35 year old Bonnie has migraines, often (but not always) with aura. Her headaches increase just before and during menses, but decrease when she takes OCPs every day (not pausing for a week as most OCPs are taken in order to trigger a reassuring ("my period started--I'm not pregnant") menstrual flow. I provided a very low estrogen dose OCP to minimize stroke risk. But she developed acne. She asked for a pill which may reduce not increase acne. Such a pill exists but appears to increase strokes more than other OCPs.
So, fewer migraines on continuous OCPs, but great risk of stroke because of her aura migraines. But some experts say never ever OCPs for women with migraines with aura, but shouldn't the patient be the one making that decision, assuming she has been presented with and understands the risk data presented above?
Ooh, that's an interesting argument for quality of life in the meantime (fewer migraines, I'm guessing better self-esteem without acne) while elevating risking both quality and quantity of life (stroke recovery/death) in the long-term. I think ultimately it's up to the patient to weigh both sides of that decision - but I reserve the right to change my opinion when it's parents refusing life-saving treatments for children :).
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