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Open Access Highly Accessed Review article

Hormonal contraception in women with migraine: is progestogen-only contraception a better choice?

Rossella E Nappi125*, Gabriele S Merki-Feld3, Erica Terreno12, Alice Pellegrinelli12 and Michele Viana4

Author Affiliations

1 Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy

2 Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy

3 Clinic for Reproductive Endocrinology, University Hospital Zürich, Zürich, Switzerland

4 Headache Science Center - National Neurological Institute C. Mondino, Pavia, Italy

5 Research Center for Reproductive Medicine, Unit of Obstetrics and Gynecology, IRCCS Policlinico ‘San Matteo’, Piazzale Golgi 2, 27100, Pavia, Italy

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The Journal of Headache and Pain 2013, 14:66  doi:10.1186/1129-2377-14-66

Published: 1 August 2013

Abstract

A significant number of women with migraine has to face the choice of reliable hormonal contraception during their fertile life. Combined hormonal contraceptives (CHCs) may be used in the majority of women with headache and migraine. However, they carry a small, but significant vascular risk, especially in migraine with aura (MA) and, eventually in migraine without aura (MO) with additional risk factors for stroke (smoking, hypertension, diabetes, hyperlipidemia and thrombophilia, age over 35 years). Guidelines recommend progestogen-only contraception as an alternative safer option because it does not seem to be associated with an increased risk of venous thromboembolism (VTE) and ischemic stroke.

Potentially, the maintenance of stable estrogen level by the administration of progestins in ovulation inhibiting dosages may have a positive influence of nociceptive threshold in women with migraine. Preliminary evidences based on headache diaries in migraineurs suggest that the progestin-only pill containing desogestrel 75 μg has a positive effect on the course of both MA and MO in the majority of women, reducing the number of days with migraine, the number of analgesics and the intensity of associated symptoms. Further prospective trials have to be performed to confirm that progestogen-only contraception may be a better option for the management of both migraine and birth control. Differences between MA and MO should also be taken into account in further studies.

Keywords:
Migraine with aura (MA); Migraine without aura (MO); Combined hormonal contraceptives (CHCs); Combined oral contraceptives (COCs); Progestogen-only contraception; Desogestrel-only pill; Venous thromboembolism (VTE); Stroke