Migraine: navigating the hormonal minefield

Afridi, Shazia

doi:10.1136/practneurol-2019-002332

Cited by 9 publications

(11 citation statements)

References 71 publications

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“…5 Many females of childbearing age who experience migraine frequently inquire about the concomitant use of contraceptives. 6 Interestingly, the use of combined hormone contraceptives containing estrogen and progestin may also contribute to migraine, primarily during hormone-free intervals. 7,8 Thus, a high prevalence of migraine among females of childbearing age and the potential of combined hormone contraceptives to contribute to migraine necessitate a careful assessment of drug interactions between a contraceptive and migraine treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Changes in estrogen levels throughout the menstrual period trigger migraine attacks in some females 5 . Many females of childbearing age who experience migraine frequently inquire about the concomitant use of contraceptives 6 . Interestingly, the use of combined hormone contraceptives containing estrogen and progestin may also contribute to migraine, primarily during hormone‐free intervals 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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Effects of rimegepant 75 mg daily on the pharmacokinetics of a combined oral contraceptive containing ethinyl estradiol and norgestimate in healthy female participants

et al. 2023

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Objective To assess the effect of single and multiple doses of rimegepant 75 mg dose on the pharmacokinetics of an oral contraceptive containing ethinyl estradiol (EE)/norgestimate (NGM) in healthy females of childbearing potential or non‐menopausal females with tubal ligation. Background Females of childbearing age experience the highest prevalence of migraine and frequently inquire about the concomitant use of anti‐migraine medications and contraceptives. Rimegepant, a calcitonin gene–related peptide receptor antagonist, demonstrated efficacy and safety for treating an acute migraine attack and preventing migraine. Methods This open‐label, single‐center, phase 1, drug–drug interaction study explored the effects of rimegepant 75 mg daily dose on the pharmacokinetics of an oral contraceptive containing EE/NGM 0.035 mg/0.25 mg in healthy females of childbearing potential or non‐menopausal females with tubal ligation. During cycles 1 and 2, participants received EE/NGM once daily for 21 days followed by placebo tablets with inactive ingredients for 7 days. Rimegepant was administered during only cycle 2 for 8 days, from days 12 through 19. The primary endpoint was the effect of single and multiple doses of rimegepant on the pharmacokinetics of EE and norelgestromin (NGMN), an active metabolite of NGM, at steady state, including area under the concentration‐time curve for 1 dosing interval (AUC0−τ,ss) and maximum observed concentration (Css[max]). Results The study enrolled 25 participants, with pharmacokinetic data assessed for 20 participants. A single 75 mg dose of rimegepant co‐administered with EE/NGM increased exposures of EE and NGMN by ≤16% (geometric mean ratio [GMR], 1.03; 90% confidence interval [CI], 1.01–1.06; and GMR, 1.16; 90% CI, 1.13–1.20, respectively). After 8 days of co‐administering EE/NGM with rimegepant, EE pharmacokinetic parameters, AUC0−τ,ss and Css(max), increased by 20% (GMR, 1.20; 90% CI, 1.16–1.25) and 34% (GMR, 1.34; 90% CI, 1.23–1.46), respectively, and NGMN pharmacokinetic parameters increased by 46% (GMR, 1.46; 90% CI, 1.39–1.52) and 40% (GMR, 1.40; 90% CI, 1.30–1.51), respectively. Conclusions The study identified modest elevations in overall EE and NGMN exposures after multiple doses of rimegepant, but these elevations are unlikely to be clinically relevant in healthy females with migraine.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of rimegepant 75 mg daily on the pharmacokinetics of a combined oral contraceptive containing ethinyl estradiol and norgestimate in healthy female participants

et al. 2023

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“…This second peak is thought to be linked to erratic fluctuations of estrogen [6 ▪ ]. Migraine commonly occurs during menses, with up to 20% of women having migraine only during menses [7 ▪▪ ]. Women with migraine have been shown to have a faster decline of estrogen levels in the late luteal phase of the menstrual cycle, which may trigger onset of migraine [8].…”

Section: Hormones and Headachementioning

confidence: 99%

“…Women with migraine have been shown to have a faster decline of estrogen levels in the late luteal phase of the menstrual cycle, which may trigger onset of migraine [8]. Migraine can continue during menopause but often declines in frequency for many women, with variable rates reported in the literature [5,6 ▪ ,7 ▪▪ ].…”

Section: Hormones and Headachementioning

confidence: 99%

“…As hormone therapy is indicated for medical management, the best course of treatment would be to treat their migraine with standard-of-care migraine regimens and offering preventive treatment aggressively to lower frequency and duration of migraine. In transgender women, it is important to recognize that they may have a higher frequency of migraine with aura or aura without migraine [7 ▪▪ ]. Frequency of migraine can be reduced by attempting to switch to a transdermal estrogen if possible [7 ▪▪ ].…”

Section: Gender-specific Treatments In Cluster Headache and Migrainementioning

confidence: 99%

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Updates on management of headache in women and transgender women

Ailani

2021

Current Opinion in Neurology

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Purpose of review Gender differences exist in headache disorders. A greater understanding of the role of hormones in headache can help the clinician better approach and manage common primary headache disorders. Recent findings Recent studies highlight differences in how migraine and cluster headache present in women and men. Updates to the ongoing debate of how to manage the use of hormones in women with migraine, especially with aura, have been well reviewed in the last 18 months. A new meta-analysis evaluates gender differences in response to triptans. Summary This review will focus on recent updates on the role of gender and hormones on migraine and cluster headache and how this may influence treatment.

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Dihydroergotamine and triptan use to treat migraine during pregnancy and the risk of adverse pregnancy outcomes

Bérard

Strom²,

Zhao

et al. 2021

Sci Rep

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Migraine is prevalent during pregnancy. Antimigraine medications such as dihydroergotamine (DHE) and triptans have been associated with adverse pregnancy outcomes in individual studies but lack of consensus remains. We compared the risk of prematurity, low birth weight (LBW), major congenital malformations (MCM), and spontaneous abortions (SA) associated with gestational use of DHE or triptans. Three cohort and one nested-case–control analyses were conducted within the Quebec Pregnancy Cohort to assess the risk of prematurity, LBW, MCM, and SA. Exposure was defined dichotomously as use of DHE or triptan during pregnancy. Generalized estimation equations were built to quantify the associations, adjusting for potential confounders. 233,900 eligible pregnancies were included in the analyses on prematurity, LBW, and MCM; 29,104 cases of SA were identified. Seventy-eight subjects (0.03%) were exposed to DHE and 526 (0.22%) to triptans. Adjusting for potential confounders, DHE and triptans were associated with increased risks of prematurity, LBW, MCM, and SA but not all estimates were statistically significant. DHE was associated with the risk of prematurity (aRR: 4.12, 95% CI 1.21–13.99); triptans were associated with the risk of SA (aOR: 1.63, 95% CI 1.34–1.98). After considering maternal migraine, all antimigraine specific medications increased the risk of some adverse pregnancy outcomes, but estimates were unstable.

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Migraine: navigating the hormonal minefield

Cited by 9 publications

References 71 publications

Effects of rimegepant 75 mg daily on the pharmacokinetics of a combined oral contraceptive containing ethinyl estradiol and norgestimate in healthy female participants

Effects of rimegepant 75 mg daily on the pharmacokinetics of a combined oral contraceptive containing ethinyl estradiol and norgestimate in healthy female participants

Updates on management of headache in women and transgender women

Dihydroergotamine and triptan use to treat migraine during pregnancy and the risk of adverse pregnancy outcomes

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