Contraceptive conundrums: A case report of a woman with migraine
Abstract
Ms. M, a 36-year-old (G0P0) Black woman seeks contraceptive counseling. She has a history of migraine headache without aura, ulcerative colitis, major depressive disorder, and obesity (body mass index [BMI], 49 kg/m). She has recently become sexually active with a man and has had one lifetime partner. Ms. M is not using any form of contraception, and her notable medications include topiramate 50 mg twice daily for migraine prophylaxis. Ms. M’s gynecologic history includes menarche at 11 years, and her menstrual cycles are irregular, occurring every few months. The patient’s levels of thyrotropin, follicle-stimulating hormone, and prolactin are normal; fi ndings on pelvic ultrasonography are also normal. Ms. M’s Papanicolaou testing is up-to-date and negative for intraepithelial lesion or cancer. The patient’s physical exam is notable for acne and hirsutism, and her vitals are as follows: temperature 98.4° F (36.9° C), pulse 76 beats per minute, respiratory rate 20, and BP 118/75 mm Hg. Ms. M’s goals for contraception are high effectiveness for pregnancy prevention, long acting and reversible characteristics, prevention of weight gain, and avoidance of injections.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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