We suggest strategies for the use of combined oral contraceptives (COCs) and hormone replacement therapy (HRT) in women with migraine, based on available evidence, when it exists, and expert opinion. They do not set a standard, since migraine management and stroke prevention require a¯exible and individualized approach, the evidence is low grade (expert appraisal of the literature with peer review (Grade C, see notes)), and no randomized controlled clinical trials exist. They do not replace general guidelines for the safe use of COCs and national recommendations that relate to migraine and COCs, where they exist. It is assumed that a diagnosis of migraine has been made and symptoms of transient ischaemic attacks, stroke or other conditions that are contraindications to the use of COCs have been ascertained. Combined oral contraceptives ' Combined oral contraceptives contain synthetic oestrogens and progestogens in doses suf®cient to inhibit ovulation.
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