A 24-year-old woman consults for contraception. She has episodic unilateral throbbing headaches preceded by flashing zigzag lines and transient loss of vision in one eye, diagnosed as migraine with aura. According to the WHO Medical Eligibility Criteria, which method should she AVOID?

• A Progestin-only pill
• B Copper intrauterine device
• C Levonorgestrel-releasing intrauterine system
• D Combined oral contraceptive pill ✓

Explanation

Migraine with aura is WHO MEC Category 4 for combined hormonal contraception because oestrogen increases the risk of ischaemic stroke in these women. Progestin-only methods are Category 1 or 2 for migraine, and both intrauterine devices carry no vascular risk, being Category 1. The aura symptoms, visual phenomena preceding the headache, are the discriminating feature that places her in Category 4 rather than the lower-risk category assigned to migraine without aura.

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.