A 33-Year-Old Woman Comes to the Office to Discuss Contraception

A 33-year-old woman comes to the office to discuss contraception options.  The patient and her boyfriend have been using condoms and the "morning-after pill" occasionally to prevent pregnancy.  She most recently used an emergency contraceptive a week ago.  The patient used combined oral contraceptives in her early 20s and would like to restart them.  Her medical conditions include occasional headaches, which she describes as a throbbing pain on the right side of her face preceded by "flickering zigzags" in her peripheral vision.  During the headache, she has light sensitivity and facial numbness.  The patient has had no previous surgeries.  Her menses are regular; her last menstrual period was 3 weeks ago.  The patient's mother was diagnosed with epithelial ovarian cancer at age 59 and is undergoing chemotherapy.  Her maternal grandmother also had ovarian cancer and died at age 56.  The patient smokes half a pack of cigarettes a week but does not use alcohol or illicit drugs.  She has no known medication allergies.  Blood pressure is 130/80 mm Hg and pulse is 76/min.  BMI is 33 kg/m².  Physical examination is normal.  Which of the following is a contraindication to the use of combined hormonal contraceptives in this patient?

A) Blood pressure
B) Family history of ovarian cancer
C) History of headaches
D) Recent emergency contraception use
E) Tobacco use