Have a female patient with a history of migraine that wants to start oral contraceptives? You might want to think twice.
Combined (estrogen plus progesterone) oral contraceptive therapy can increase migraine frequency, severity, and can be associated with focal neurological symptoms.
In addition, women with migraine who use oral contraceptives are at a 2-4 fold increased risk of ischemic stroke compared to women with migraines who do not use oral contraceptives.
So, if you have a female patient who has migraine (with aura especially), you should not prescribe them combined oral contraceptives. Consider other birth control options instead.