The Role of Combined Hormonal Contraceptives in Migraine
The Role of Combined Hormonal Contraceptives in Migraine
Higher concentrations of estrogen are associated with increased aura frequency; conversely, low estrogen concentrations, such as the environment of menses, are less likely to be associated with aura. Today, however, some CHCs inhibit ovulation with mid-physiological doses of estrogen, resulting in lower peak concentrations than those produced in the natural menstrual cycle.
A recent pilot study provided a preliminary look at the effect of one of these products on migraine aura. A retrospective database review of 830 women seeking treatment at a headache specialty clinic identified 28 women with MwA, as well as intractable MRM, who had been prescribed therapy with extended-cycle dosing of NuvaRing®. This ultralow-dose parenteral CHC releases only 15 μg EE/24 hours. Therapy was associated with a reduction in aura frequency from 3.5 auras per month at baseline to 0.6 auras per month after a mean follow-up of 8 months. No subject experienced an increase in aura frequency, and MRM was eliminated in 91.3% of women.
Should CHCs be Contraindicated in MWA?
Higher concentrations of estrogen are associated with increased aura frequency; conversely, low estrogen concentrations, such as the environment of menses, are less likely to be associated with aura. Today, however, some CHCs inhibit ovulation with mid-physiological doses of estrogen, resulting in lower peak concentrations than those produced in the natural menstrual cycle.
A recent pilot study provided a preliminary look at the effect of one of these products on migraine aura. A retrospective database review of 830 women seeking treatment at a headache specialty clinic identified 28 women with MwA, as well as intractable MRM, who had been prescribed therapy with extended-cycle dosing of NuvaRing®. This ultralow-dose parenteral CHC releases only 15 μg EE/24 hours. Therapy was associated with a reduction in aura frequency from 3.5 auras per month at baseline to 0.6 auras per month after a mean follow-up of 8 months. No subject experienced an increase in aura frequency, and MRM was eliminated in 91.3% of women.
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