The benefits of contraceptives in the management of menstrual migraine

The benefits of contraceptives in the management of menstrual


A MacGregor

The City of London Migraine Clinic, London, United Kingdom

More than 50% of women with migraine, both in the general

population and presenting to specialist clinics, report an association between

migraine and menstruation. There is evidence that menstrual attacks of migraine

are associated, at least in some women, with falling levels or ‘withdrawal’ of

estrogen during the late luteal phase of the menstrual cycle. Suppression of

cyclical ovarian activity with combined hormonal contraception (CHC) is an

effective theoretical strategy but in practice migraine can be triggered by

estrogen ‘withdrawal’ during the hormone-free interval. Extending the active

interval and shortening the hormone-free interval is becoming increasingly

popular [1]. However, no double-blind, placebo-controlled trials, or even

open-label trials, of this strategy have been undertaken for this indication.

Progestogen-only contraception has the advantage of continuous administration

and, unlike CHCs is not even contraindicated for women with aura [2]. But

standard contraceptive oral progestogens do not consistently inhibit ovulation

and the resultant disrupted menstrual cycle can be associated with increased

migraine frequency and severity. In contrast, higher doses of standard oral

progestogens, sufficient to inhibit ovulation, can prevent menstrual migraine

[3]. On this basis Cerazette®, a licensed anovulatory progestogen-only pill may

have advantages over standard progestogen-only pills for women with migraine.

Interim results from an ongoing study show benefit and formal trials with

Cerazette® for the management of menstrual migraine are indicated.


  1. Sulak PJ, Carl J, Gopalakrishnan I, Coffee A, Kuehl TJ.

    Otcomes of extended oral contraceptive regimens with a shortened

    hormone-free interval to manage breakthrough bleeding. Contraception


  2. World Health Organization. Improving access to quality care

    in family planning. Medical eligibility criteria for initiating and

    continuing use of contraceptive methods. Third ed. Geneva:WHO,2004.

  3. Davies P, Fursdon-Davies C, Rees M. Progestogens for

    menstrual migraine. J Br Men Soc 2003;9(3):134.

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