The benefits of contraceptives in the management of menstrual
migraine
A MacGregor
The City of London Migraine Clinic, London, United Kingdom
More than 50% of women with migraine, both in the general
population and presenting to specialist clinics, report an association between
migraine and menstruation. There is evidence that menstrual attacks of migraine
are associated, at least in some women, with falling levels or ‘withdrawal’ of
estrogen during the late luteal phase of the menstrual cycle. Suppression of
cyclical ovarian activity with combined hormonal contraception (CHC) is an
effective theoretical strategy but in practice migraine can be triggered by
estrogen ‘withdrawal’ during the hormone-free interval. Extending the active
interval and shortening the hormone-free interval is becoming increasingly
popular [1]. However, no double-blind, placebo-controlled trials, or even
open-label trials, of this strategy have been undertaken for this indication.
Progestogen-only contraception has the advantage of continuous administration
and, unlike CHCs is not even contraindicated for women with aura [2]. But
standard contraceptive oral progestogens do not consistently inhibit ovulation
and the resultant disrupted menstrual cycle can be associated with increased
migraine frequency and severity. In contrast, higher doses of standard oral
progestogens, sufficient to inhibit ovulation, can prevent menstrual migraine
[3]. On this basis Cerazette®, a licensed anovulatory progestogen-only pill may
have advantages over standard progestogen-only pills for women with migraine.
Interim results from an ongoing study show benefit and formal trials with
Cerazette® for the management of menstrual migraine are indicated.
References
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Sulak PJ, Carl J, Gopalakrishnan I, Coffee A, Kuehl TJ.
Otcomes of extended oral contraceptive regimens with a shortened
hormone-free interval to manage breakthrough bleeding. Contraception
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World Health Organization. Improving access to quality care
in family planning. Medical eligibility criteria for initiating and
continuing use of contraceptive methods. Third ed. Geneva:WHO,2004.
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Davies P, Fursdon-Davies C, Rees M. Progestogens for
menstrual migraine. J Br Men Soc 2003;9(3):134.