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Evidence shows that combined oral contraceptives are contraindicative in women who have migraines with auras (MA) due to increased risk of ischemic stroke. So what can these women do?
Evidence shows that combined oral contraceptives are contraindicative in women who have migraines with auras (MA) due to increased risk of ischemic stroke. So what can these women do? Since progestin-only contraceptive pills are considered to be safe and effective and are often used in women with cerebrovascular diseases or risk factors for stroke, Dr Rossella E. Nappi, assistant professor of obstetrics and gynecology at the University of Pavia, Italy, and colleagues sought to determine if this kind of oral contraceptive would be beneficial in women with MAs as well.
The study included 30 women who were suffering from MA. Most of the women (60%) reported more than one attack of MA per month over the 3 months preceding the study. Visual symptoms were present in 93% of the participants. The women also reported sensory symptoms (50% of the participants), speech symptoms (20%), and motor weakness (13.3%). Fifteen of the women had never received oral contraceptives; the remaining 15 received a diagnosis while they were taking combined oral contraceptives but wanted to continue oral contraception. Migraines were being treated mostly with nonsteroidal anti-inflammatory medications; the women were not using any migraine drug prophylaxis before entering the study.
The researchers followed participants for 9 months, during which time the women completed diary entries and recorded headache information. Specifically, the researchers asked the women to document the number of MA attacks, duration of aura, duration of headache pain, pain severity, the occurrence of reversible focal neurological symptoms, the occurrence of associated phenomena, number of analgesics used per attack, and the number of days where there was spotting or bleeding. After the initial 3 months, the women received an estrogen-free DSG-containing oral contraception or progestin-only contraceptive pill.
Overall, the progestin-only contraceptive was well tolerated. The number of spotting days significantly increased; none of the participants experienced amenorrhea. Furthermore, by the end of the study, the number of MA attacks was significantly reduced. The researchers further found a significant reduction in the duration of visual aura and the total duration of neurological symptoms in women who previously used combined oral contraceptives.
Nappi and colleagues further noted a reduction in the use of analgesic consumption for all study participants. Incidence of vomiting and nausea was also reduced, going from 22.5% to 10% and 70% to 62.5% of participants, respectively.
“Our results are the first to confirm the belief that POP [progestin-only contraceptive pill] containing 75 mcg/day DSG can be safely used, at least for a short period of time, in a clinical population of women with MA wishing to use hormonal contraception,” noted Nappi and colleagues. “Indeed, there is no evidence that use of POPs is associated with an increased risk of ischemic stroke.”
They cautioned, “Long-term follow-up is, however, needed to further corroborate the safety profile of such a POP in MA, an established risk factor for cardiovascular diseases and ischemic lesions of the brain.”
Nappi RE, Sances G, Allais G, et al.Effects of an estrogen-free, desogestrel-containing oral contraceptive in women with migraine with aura: a prospective diary-based pilot study. [http://www.ncbi.nlm.nih.gov/pubmed/21310283] Contraception. 2011 Mar;83(3):223-8.