What is a firm contraindication for the use of combined oral contraceptives?

The use of combined oral contraceptives is contraindicated in patients with a history of migraine with aura due to the increased risk of stroke associated with estrogen-containing medications. Migraines with aura are characterized by neurological symptoms, such as visual disturbances, which can indicate increased susceptibility to vascular events. This heightened risk is particularly relevant for women who are of reproductive age and may be prescribed hormonal contraception.

In contrast, a remote history of a provoked deep vein thrombosis (DVT) after surgery typically does not preclude the use of combined oral contraceptives, especially if the DVT was related to a temporary condition. A history of cluster headaches and migraines without aura also does not carry the same level of risk associated with combined oral contraceptives as migraines with aura do, making them less concerning in terms of contraindications. Thus, the critical factor leading to the contraindication is the association between migraine with aura and an increased risk of thromboembolic events, reinforcing the need for careful patient evaluation in contraceptive planning.