Priority 14 from the Contraception PSP

UNCERTAINTY: What is the risk of stroke for women suffering from migraines who are using combined hormonal contraception (pill, patch, ring)?  (JLA PSP Priority 14)
Overall ranking 14
JLA question ID 0049/14
Explanatory note About one in six women get migraine headaches. It is thought that combined hormonal contraception increases the chance of stoke in women with migraine, for this reason use of these methods is not advised. This effectively removes the option of the most popular contraceptive method (oral combined contraceptive pill) from 1 in six women. 
Evidence

Safety of hormonal contraceptives among women with migraine: A systematic review, Naomi K. Tepper, Maura K. Whiteman, Lauren B. Zapata, Polly A. Marchbanks, Kathryn M. Curtis. Contraception, Vol. 94, Issue 6, p630–640Published online: May 3, 2016, PreviewFull-Text HTMLPDF 

Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Rachel E.J. Roach, Frans M Helmerhorst, Willem M. Lijfering, Theo Stijnen, Ale Algra, Olaf M Dekkers.  August 2015  

Combined oral contraceptives: venous thrombosis Marcos de Bastos, Bernardine H. Stegeman, Frits R. Rosendaal, Astrid Van Hylckama Vlieg, Frans M Helmerhorst, Theo Stijnen, Olaf M Dekkers. March 2014 
Health Research Classification System category Reproductive Health and Childbirth
Extra information provided by this PSP
Original uncertainty examples

“I am unable to take the COCP as I get migraines - what is the risk? “ (Patient)  ~  “Do we need to rethink the absolute ban on chc in migraine with aura? The relative risk is high but the absolute risk is very low” (HCP)

 
Submitted by Healthcare Professionals x 4~Patients x 5~Both x 0
PSP information
PSP unique ID 0049
PSP name Contraception
Total number of uncertainties identified by this PSP. 57  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 21 April 2017