Diagnosis and Treatment of Headache. On Estrogen-Containing Contraceptives or Considering Estrogen-Containing Contraceptives with Migraine Algorithm.

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jan. 70 p. Diagnosis and Treatment of Headache On Estrogen-Containing Contraceptives or Considering Estrogen-Containing Contraceptives with Migraine Algorithm On estrogen-containing contraceptives or considering estrogen-containing contraceptives with migraine. A The patient would enter this algorithim from box 54 of the Migraine Treatment Algorithm. Patient prefers non-estrogen birth control? Evaluate vascular risk factors: *Risk factors for CAD. *Migraine aura. *Existing laboratory evidence of hypercoagulability. *Prior thromboembolic disease. *Current tobacco use. A *Progestin methods - Progestin-only contraceptives. - Depo-Provera. *Nonhormonal contraceptive methods. *IUD; barrier method. At risk? Headaches worsen? *Increase in frequency. *Increase in severity. *Develop an aura. Low-estrogen contraceptives Continue therapy *Consider discontinuing progestin. *Reassess causes for concern. *Consider specialty consultation. *Return to Migraine Treatment Algorithm. Headaches worsen? *Increase in frequency. *Increase in severity. *Develop an aura. Continue therapy *Consider adding oral or transdermal estrogen during placebo week. *Discontinue estrogen-containing contraceptives. *Consider progestin methods or nonhormonal contraceptive methods. *Reassess causes for concern. *Consider specialty consultation. *Return to Migraine Treatment algorithm. A = Annotation All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.