Migraine and vascular-type headaches have often been associated with combined estrogen-progestogen oral contraceptive use. 20 women with complaints of headache 25 of whom had a history of migraine prior to oral contraceptive use were studied for onset and variations of migraine attack during the menstrual cycle while receiving a variety of combined oral contraceptive formulations. Generally migraine attacks were more severe under the oral contraceptive regimen and attacks seemed more frequent between cycles and during the first few days of the resumed regimen. Formulations with a low proportion of progestogen reduced the severity of and sometimes abolished the headaches. Intervals between attacks were usually longer with the lowered progestogen content. It is concluded that exogenous progestogen preparations will stimulate migraine in patients with a constitutional predisposition towards vascular-type headache and that withdrawal from the drug is the stimulus for the migraine attack.
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