A 28-year-old woman with migraine asks for advice on starting a combined oral contraceptive pill. Which feature in her headache history represents an absolute contraindication to combined hormonal contraception?
- A Migraine without aura occurring during the pill-free week
- B Migraine with visual aura ✓
- C Menstrual migraine limited to days 1 to 3 of the cycle
- D Family history of migraine in her mother
Correct answer: B. Migraine with visual aura
Explanation
Migraine with aura at any age is a WHO medical eligibility criterion category 4 condition for combined hormonal contraception, because aura itself confers an increased risk of ischaemic stroke that oestrogen-containing pills further raise. Migraine without aura is only category 3 if it starts or worsens while on the pill, and menstrual migraine without aura permits use. A family history alone is not a contraindication.
Reference: WHO Medical Eligibility Criteria for Contraceptive Use, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.