Use of Hormonal Contraception in Women Suffering From Migraine [6S

Abstract

INTRODUCTION: Migraine is a common condition in reproductive age women, with menses as a frequent trigger. The use of continuous combined hormonal contraception (CHC) has been shown to reduce the frequency of estrogen-associated migraine by as much as 80%. With newer low-dose estrogen formulas, the Centers for Disease Control and Prevention (CDC) re-categorized CHC as acceptable for women with migraine without aura. The International Headache Society Task Force concluded that low-risk patients may benefit from CHC regardless of the presence of aura. We hypothesized that CHC is underutilized in appropriate candidates despite recent guidelines. METHODS: An IRB-approved retrospective chart review was performed to assess the use of hormonal suppression in women with migraine. Electronic medical records were reviewed over two years for women age 18-50 suffering from migraine. Patient data extracted included demographics, medical history, and medications. RESULTS: A total of 7,451 female migraine suffers were identified, the majority (n=6,404, 85.9%) without aura. 18.9% of all patients were identified as having at least one risk factor for CHC use, primarily smoking or hypertension. There was no statistically significant difference in hormone utilization based on headache type; 22% of patients without aura (20.4% pills, 1.4% ring, 0.2% patch) and 19.8% of those with aura (18.1% pills, 1.6% ring and 0.1% patch). There also was no difference among those identified specifically as menstrual migraine (27.3% pill, 1% ring). CONCLUSION: The majority of patients with migraine are low risk for CHC and potential candidates for hormonal suppression.