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Considerations for Contraceptive Use Among Patients with Migraines. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023. [DOI: 10.1007/s13669-023-00349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Purpose of Review
There is an overlap in the populations of patients who suffer from migraine headaches and patients who seek contraception. The purpose of this review is to present recent studies on contraception among patients with migraines and provide clinical recommendations.
Recent Findings
Migraine with aura and combined hormonal contraceptive (CHC) use are associated with increased ischemic stroke risk. The use of CHCs in patients with migraine with aura produces a higher risk of ischemic stroke than either factor individually; therefore, CHC is contraindicated in this population by certain guidelines. However, recent studies suggest that oral contraceptive may reduce migraine days, pain scores, and migraine medication use.
Summary
Certain guidelines recommend against use of CHCs in patients with migraine with aura. CHC use is acceptable among patient with migraines without aura. In patients with menstrual-related migraines, there may be benefit from continuous use of oral contraceptives. Further studies are needed on migraine and specific formulations of CHC, if the frequency of migraines with aura impacts ischemic stroke risk and the impact of oral and non-oral contraceptives on menstrual headaches.
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Merki-Feld GS, Sandor PS, Nappi RE, Pohl H, Schankin C. Clinical features of migraine with onset prior to or during start of combined hormonal contraception: a prospective cohort study. Acta Neurol Belg 2022; 122:401-409. [PMID: 33928470 PMCID: PMC8986701 DOI: 10.1007/s13760-021-01677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/10/2021] [Indexed: 12/02/2022]
Abstract
Many studies have described the features of menstrually related migraines but there is a lack of knowledge regarding the features of migraine in combined hormonal contraceptive users (CHC). Hormone-withdrawal migraines in the pill-free period could differ from those in the natural cycle. Gynaecologic comorbidities, like dysmenorrhea and endometriosis, but also depression or a family history might modify the course of migraine. A better understanding of migraine features linked to special hormonal situations could improve treatment. For this prospective cohort study, we conducted telephone interviews with women using a CHC and reporting withdrawal migraine to collect information on migraine frequency, intensity, triggers, symptoms, pain medication, gynaecologic history and comorbidities (n = 48). A subset of women agreed to also document their migraines in prospective diaries. The mean number of migraine days per cycle was 4.2 (± 2.7). Around 50% of these migraines occurred during the hormone-free interval. Migraine frequency was significantly higher in women who suffered from migraine before CHC start (5.0 ± 3.1) (n = 22) in comparison to those with migraine onset after CHC start (3.5 ± 2.1) (n = 26). Menstrually related attacks were described as more painful (57.5%), especially in women with migraine onset before CHC use (72%) (p < 0.02). Comorbidities were rare, except dysmenorrhea. The majority of migraine attacks in CHC users occur during the hormone-free interval. Similar as in the natural cycle, hormone-withdrawal migraines in CHC users are very intense and the response to acute medication is less good, especially in those women, who developed migraine before CHC use.
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Review of migraine incidence and management in obstetrics and gynaecology. Eur J Obstet Gynecol Reprod Biol 2019; 240:248-255. [DOI: 10.1016/j.ejogrb.2019.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 12/30/2022]
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Peng KP, May A. Oral contraceptive use and its association with symptomatology in migraine patients. CEPHALALGIA REPORTS 2019. [DOI: 10.1177/2515816319856007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Hormonal changes in natural menstrual cycles are known to modulate and even worsen headache symptoms in migraineurs; however, the impact of oral contraceptive pills (OCP), including combined oral contraceptive (COC) and progestogen-only pills on migraine symptomatology, is little investigated. Method: In this retrospective cohort study of 1758 migraine patients, data from 1032 female patients aged 15–45 years were accessed and their contraceptive methods, if any, were analyzed. Further comparisons were conducted between patients with OCP use and those without OCP use regarding the demographics, headache symptoms, and associated symptoms. Most OCP users in this study were assumed to have used COC, but information of individual hormone content of OCP was not collected. Patients with nonoral hormonal contraceptives were excluded for further comparison. Results: The use of OCP was common (47.8%) among the study cohort. Compared to those without OCP use ( n = 410), patients with OCP use ( n = 493) were younger (27.4 ± 7.0 vs. 32.8 ± 7.9, p < 0.001), had lower headache frequency (days per month, 11.1 ± 7.5 vs. 12.3 ± 8.8, p = 0.03), were less likely to have osmophobia (47.3 vs. 54.4%, p = 0.033) or cranial autonomic symptoms (44.8 vs. 53.2%, p = 0.013), and more commonly reported menstrually-related worsening of headache (52.3 vs. 42.4%, p = 0.012). The proportion of migraine with aura or other headache characteristics including severity, unilaterality, and pulsatile characteristic showed no differences between groups. Conclusion: Our data provide real-life information about contraceptive use among patients with migraine. The use of OCP is associated with differences in migraine symptomatology. Further studies are needed to determine whether this relationship is causal and any possible underlying mechanism.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Delaruelle Z, Ivanova TA, Khan S, Negro A, Ornello R, Raffaelli B, Terrin A, Mitsikostas DD, Reuter U. Male and female sex hormones in primary headaches. J Headache Pain 2018; 19:117. [PMID: 30497379 PMCID: PMC6755575 DOI: 10.1186/s10194-018-0922-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The three primary headaches, tension-type headache, migraine and cluster headache, occur in both genders, but all seem to have a sex-specific prevalence. These gender differences suggest that both male and female sex hormones could have an influence on the course of primary headaches. This review aims to summarise the most relevant and recent literature on this topic. METHODS Two independent reviewers searched PUBMED in a systematic manner. Search strings were composed using the terms LH, FSH, progesteron*, estrogen*, DHEA*, prolactin, testosterone, androgen*, headach*, migrain*, "tension type" or cluster. A timeframe was set limiting the search to articles published in the last 20 years, after January 1st 1997. RESULTS Migraine tends to follow a classic temporal pattern throughout a woman's life corresponding to the fluctuation of estrogen in the different reproductive stages. The estrogen withdrawal hypothesis forms the basis for most of the assumptions made on this behalf. The role of other hormones as well as the importance of sex hormones in other primary headaches is far less studied. CONCLUSION The available literature mainly covers the role of sex hormones in migraine in women. Detailed studies especially in the elderly of both sexes and in cluster headache and tension-type headache are warranted to fully elucidate the role of these hormones in all primary headaches.
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Affiliation(s)
- Zoë Delaruelle
- Department of Neurology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | | | - Sabrina Khan
- Danish Headache Center, Glostrup Hospital, Copenhagen, Denmark
| | - Andrea Negro
- Dipartimento di Medicina Clinica e Molecolare, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | - Raffaele Ornello
- Department of Neurology, University of La’Aquila, L’Aquila, Italy
| | - Bianca Raffaelli
- Departmentt of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alberto Terrin
- Department of Neurosciences, Headache Center, University of Padua, Padua, Italy
| | - Dimos D. Mitsikostas
- Neurology Department, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Uwe Reuter
- Charite Universitatsmedizin Berlin, Berlin, Germany
| | - on behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
- Department of Neurology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- First Moscow State Medical University, Moscow, Russia
- Danish Headache Center, Glostrup Hospital, Copenhagen, Denmark
- Dipartimento di Medicina Clinica e Molecolare, Universita degli Studi di Roma La Sapienza, Rome, Italy
- Department of Neurology, University of La’Aquila, L’Aquila, Italy
- Departmentt of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurosciences, Headache Center, University of Padua, Padua, Italy
- Neurology Department, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Charite Universitatsmedizin Berlin, Berlin, Germany
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Sacco S, Merki-Feld GS, Ægidius KL, Bitzer J, Canonico M, Gantenbein AR, Kurth T, Lampl C, Lidegaard Ø, Anne MacGregor E, MaassenVanDenBrink A, Mitsikostas DD, Nappi RE, Ntaios G, Paemeleire K, Sandset PM, Terwindt GM, Vetvik KG, Martelletti P. Effect of exogenous estrogens and progestogens on the course of migraine during reproductive age: a consensus statement by the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESCRH). J Headache Pain 2018; 19:76. [PMID: 30171365 PMCID: PMC6119173 DOI: 10.1186/s10194-018-0896-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/30/2018] [Indexed: 01/03/2023] Open
Abstract
We systematically reviewed data about the effect of exogenous estrogens and progestogens on the course of migraine during reproductive age. Thereafter a consensus procedure among international experts was undertaken to develop statements to support clinical decision making, in terms of possible effects on migraine course of exogenous estrogens and progestogens and on possible treatment of headache associated with the use or with the withdrawal of hormones. Overall, quality of current evidence is low. Recommendations are provided for all the compounds with available evidence including the conventional 21/7 combined hormonal contraception, the desogestrel only oral pill, combined oral contraceptives with shortened pill-free interval, combined oral contraceptives with estradiol supplementation during the pill-free interval, extended regimen of combined hormonal contraceptive with pill or patch, combined hormonal contraceptive vaginal ring, transdermal estradiol supplementation with gel, transdermal estradiol supplementation with patch, subcutaneous estrogen implant with cyclical oral progestogen. As the quality of available data is poor, further research is needed on this topic to improve the knowledge about the use of estrogens and progestogens in women with migraine. There is a need for better management of headaches related to the use of hormones or their withdrawal.
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Affiliation(s)
- Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | - Gabriele S Merki-Feld
- Clinic for Reproductive Endocrinology, Department of Gynecology, University Hospital, Zürich, Switzerland
| | - Karen Lehrmann Ægidius
- Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Johannes Bitzer
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Marianne Canonico
- Université Paris-Saclay, University Paris-Sud, UVSQ, CESP, Inserm UMRS1018, Paris, France
| | - Andreas R Gantenbein
- Neurology & Neurorehabilitation, RehaClinic, Bad Zurzach, University of Zurich, Zürich, Switzerland
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Lampl
- Headache Medical Center Seilerstaette Linz, Linz, Austria.,Department of Geriatric Medicine Ordensklinikum Linz, Linz, Austria
| | - Øjvind Lidegaard
- Department of Obstetrics & Gynaecology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - E Anne MacGregor
- Centre for Neuroscience & Trauma, BICMS, Barts and the London School of Medicine and Dentistry, London, UK.,Barts Health NHS Trust, London, UK
| | - Antoinette MaassenVanDenBrink
- Erasmus Medical Center Rotterdam, Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Rotterdam, The Netherlands
| | | | - Rossella Elena Nappi
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,University Consortium for Adaptive Disorders and Head Pain (UCADH), University of Pavia, Pavia, Italy
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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Hipolito Rodrigues MA, Maitrot-Mantelet L, Plu-Bureau G, Gompel A. Migraine, hormones and the menopausal transition. Climacteric 2018. [DOI: 10.1080/13697137.2018.1439914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- M. A. Hipolito Rodrigues
- Departments of Surgery, Gynecology, Obstetrics and Propedeutics, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - L. Maitrot-Mantelet
- Department of Gynecology, Assistance Publique-Hôpitaux de Paris, HUPC, Paris, France
| | - G. Plu-Bureau
- Department of Gynecology, Université Paris Descartes, HUPC, Paris, France
| | - A. Gompel
- Department of Gynecology, Université Paris Descartes, HUPC, Paris, France
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Allais G, Chiarle G, Sinigaglia S, Benedetto C. Menstrual migraine: a review of current and developing pharmacotherapies for women. Expert Opin Pharmacother 2017; 19:123-136. [PMID: 29212383 DOI: 10.1080/14656566.2017.1414182] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Migraine is one of the most common neurological disorders in the general population. It affects 18% of women and 6% of men. In more than 50% of women migraineurs the occurrence of migraine attacks correlates strongly with the perimenstrual period. Menstrual migraine is highly debilitating, less responsive to therapy, and attacks are longer than those not correlated with menses. Menstrual migraine requires accurate evaluation and targeted therapy, that we aim to recommend in this review. AREAS COVERED This review of the literature provides an overview of currently available pharmacological therapies (especially with triptans, anti-inflammatory drugs, hormonal strategies) and drugs in development (in particular those acting on calcitonin gene-related peptide) for the treatment of acute migraine attacks and the prophylaxis of menstrual migraine. The studies reviewed here were retrieved from the Medline database as of June 2017. EXPERT OPINION The treatment of menstrual migraine is highly complex. Accurate evaluation of its characteristics is prerequisite to selecting appropriate therapy. An integrated approach involving neurologists and gynecologists is essential for patient management and for continuous updating on new therapies under development.
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Affiliation(s)
- G Allais
- a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy
| | - Giulia Chiarle
- a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy
| | - Silvia Sinigaglia
- a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy
| | - Chiara Benedetto
- a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy
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