Contraceptive-induced amenorrhoea leads to reduced migraine frequency in women with menstrual migraine without aura

Abstract

BackgroundMenstrual migraine without aura (MM) affects approximately 20% of female migraineurs in the general population. The aim of the present study was to investigate the influence of contraception on the attacks of migraine without aura (MO) in women with MM.Findings141 women from the general population with a history of MM according to the International Classification of Headache Disorders II (ICHD II) were interviewed by a headache specialist. Of 49 women with a history of MM currently using hormonal contraception, 23 reported amenorrhoea. Significantly more women with amenorrhoea reported no MO- days during the preceding month compared to women without amenorrhoea (OR 16.1; 95% confidence interval (CI) 1.8-140.4; P = 0.003). A reduction of MO-frequency was more often reported in women with than without amenorrhoea (OR 3.5; 95% CI 1.1-11.4; P = 0.04).ConclusionAmenorrhoea leads to a reduction of MO-frequency in women with MM using hormonal contraceptives. Future prospective studies on MM should focus on contraceptive methods that achieve amenorrhoea.

Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis

“…However, other progestin-only treatments such as the LNG-IUS, which exerts its hormonal action at a local level within the uterus, rather than through inhibition of ovulation, or the lower-dose POPs, which act primarily through their effect on cervical mucus, may have not have the same effect on migraine. It is possible that amenorrhoea may also impact on migraine symptoms (37), which may provide an additional mechanism for contraceptives such as the etonogestrel implant and LNG-IUS. The practical application of these findings is also geographically-specific, as the desogestrel 75 mcg/ day pill is not approved for clinical use in some countries including Australia.…”

Practice Guideline: Contraception for Adolescents with Chronic Illness

“…The etiology is multifaceted: a drop in estrogen levels, such as in the perimenstrual phase of the menstrual cycle or the hormone-free interval of contraceptives, often triggers a migraine. Eliminating this hormonefree interval may decrease migraine frequency by preventing the estrogen level drop (Vetvik, MacGregor, Lundqvist, & Russell, 2014). Choices include an extended therapy of combined oral contraceptives (2014); Lexi-Drugs (2017a, 2017b, 2017c, 2017d).…”

“…In addition to reducing migraine frequency, these medications may also reduce headache frequency, pain intensity, and pain medication use. A small subset of migraineurs experienced an increase in their migraines and headaches after commencing hormonal therapy (MerkiFeld et al, 2013;Morotti, Remorgida, Venturini, & Ferrero, 2014;Vetvik et al, 2014).…”

Headache management: pharmacological approaches

“…Contraceptive-induced amenorrhoea can also be very effective, for example, with tricycling or continuous combined contraceptive pill. 27 Oestrogen gels or patches can ameliorate the effect of falling serum hormone concentrations before and during the period (eg, 1.5 mg transcutaneous oestrogen days −2 to +5).…”