Primary care use of combined hormonal contraceptives in women with migraine with aura.
ESC Congress Library. Adan G. May 28, 2014; 50492; A-076
Mr. Guleed Adan
Mr. Guleed Adan
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1. Objectives

According to the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) guidelines, produced by the Faculty of Sexual and Reproductive Healthcare (FSRH), the use of combined hormonal contraceptives (CHCs) in women known to have migraine with aura is a UKMEC 4 (A condition which represents an unacceptable health risk if the contraceptive method is used). This is due to the increased risk of ischaemic stroke that CHC causes in women that have migraine with aura.

The main objective of the audit was to assess whether the UKMEC guidelines were being adhered to in this particular primary care centre and if they weren’t what the shortcomings were so that this could be rectified in future contraceptive prescribing policy.

2. Method

A thorough audit of the electronic healthcare records was carried out in a busy inner city General Practice. This involved studying the records of all women who had been prescribed CHCs in the preceding 12 months. The system was then used to check how many of these women had a known history of migraine, more specifically migraine with aura. A ‘known history’ was taken to be at least one recorded presentation in the electronic healthcare records. We then looked at the last consultation with each of the women when they were prescribed their annual supply of CHCs to elicit whether they were specifically asked about a history of migraine.

3. Results

We found that of the 750 women who were prescribed CHCs in the past 12 months, 36 of them had a known history of migraine, 17 of which had migraine with aura. In the consultations these 36 women had with health care professionals based at the practice, only on 4 occasions were they asked about a personal history of migraine.

4. Conclusions

It is clear that this practice was not adhering to the UKMEC guidelines about the prescription of CHCs in women who have migraine with aura. It is apparent that this needs addressing to ensure that women are not unnecessarily placed at increased risk of ischaemic stroke due to inappropriate contraception prescribing habits. This was a busy general practice that can be said to be fairly representative of other primary care centres in the UK, therefore a case can be argued to perform a nationwide audit of prescribing practices of contraception in General Practice to ensure adherence with UKMEC guidelines.

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