American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication should not be combined with triptans due to increased stroke risk in women with migraine with aura?

1. Propranolol

2. Amlodipine

3. Estrogen-containing oral contraceptives

4. Gabapentin

The correct answer is: Estrogen-containing oral contraceptives

Triptans are commonly prescribed for migraine relief, particularly in patients who experience migraines with aura. These medications work by constricting blood vessels and alleviating headache symptoms. However, when triptans are combined with estrogen-containing oral contraceptives, the risk for vascular complications, including stroke, is significantly increased, especially in women with a history of migraine with aura. The reason for this increased risk lies in the interplay between estrogen and triptans. Estrogen can enhance the thrombotic effects, potentially leading to vasoconstriction and increasing the likelihood of clot formation. This combination poses a higher risk for women who already have an increased susceptibility to stroke due to the presence of aura during their migraines. Other medications listed have different mechanisms of action and do not carry the same heightened risk when used alongside triptans. For instance, propranolol is a beta-blocker often used not only for migraine prophylaxis but also for cardiovascular health, and studies have indicated that it does not significantly increase stroke risk in this population. Amlodipine, a calcium channel blocker, is used mainly for hypertension and has no such contraindications with triptans. Gabapentin, used for neuropathic pain and sometimes migraines, does not interact