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Diagnosing migraine
  1. E Anne MacGregor1,2
  1. 1Associate Specialist, Barts Health NHS Trust, London, UK
  2. 2Associate Specialist, Centre for Neuroscience & Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
  1. Correspondence to Dr E Anne MacGregor, Barts Sexual Health Centre, Kenton and Lucas Block, St Bartholomew's Hospital, London EC1A 7BE, UK; anne{at}


Migraine is a common headache disorder, particularly in women. It usually starts during the teens and twenties, a time when many women are seeking contraception advice. Migraine without aura is the most prevalent type of migraine, affecting up to 70% of people with migraine, while the remainder experience attacks with and/or without aura. Aura is a phase of focal neurological symptoms, typically visual. An increasing body of evidence identifies aura as a marker of increased risk of ischaemic stroke and its presence is a contraindication to the use of combined hormonal contraception (CHC). However, aura is often confused with more generalised premonitory visual symptoms of migraine that may precede attacks of migraine with and without aura, which are not associated with stroke risk. Diagnostic confidence is needed so that CHC is not withheld unnecessarily.

  • aura
  • headache
  • migraine with aura
  • migraine without aura
  • contraception

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  • Competing interests In the last 3 years the author has acted as a paid consultant to, and/or her department has received research funding from, Bayer Healthcare, Consilient Health, and Menarini.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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