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.
Highlights
Migraine is a disabling headache, characterized by moderate to severe head pain, usually accompanied by nausea, photophobia, phonophobia and osmophobia
The beneficial effect of desogestrel 75 μg on visual and other neurological symptoms of aura was significantly present only in those women in whom migraine with aura (MA) onset was related to previous COCs treatment. These findings suggest that the reduction in estrogen levels may be relevant to the amelioration of MA, but do not exclude a direct effect of the progestin on cortical spreading depression (CSD)
In conclusion, contraceptive counseling in migraine should take into account the risk-benefit profile of the individual woman before prescribing Combined hormonal contraceptives (CHCs)
Summary
Migraine is a disabling headache, characterized by moderate to severe head pain, usually accompanied by nausea, photophobia, phonophobia and osmophobia (migraine without aura, MO). We believe it is relevant for clinical practice to briefly review in here potential vascular risks according to the category of migraine, with and without aura, and to the type of hormonal contraceptive option.
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