title: Effects of an estrogen-free, desogestrel-containing oral contraceptive in women with migraine with aura: a prospective diary-based pilot study.
abstract: BACKGROUND
  Migraine with aura (MA) is a contraindication to the use of combined oral contraceptives (COCs) because of the increased risk of ischemic stroke. Progestogen-only contraceptive pill (POP) is a safe alternative to COCs and it is preferable in women with cerebrovascular diseases or risk factors for stroke.
  
  
  METHODS
  Prospective diary-based pilot study. Thirty women with MA (n = 15 who have never used COCs and n = 15 who had previously used COCs were diagnosed according to the International Headache Society criteria. The observational period lasted 9 months during which women filled in a diary with the clinical characteristics of headache attacks. After a 3-month run-in period, each subject received an estrogen-free desogestrel (DSG) (75 mcg/day)-containing OC (Cerazette(®); Schering-Plough, formerly NV Organon, Oss, The Netherlands). Follow-up evaluations were planned at the end of the third and sixth month of treatment.
  
  
  RESULTS
  The number (mean±S.D.) of migraine attacks was significantly reduced both in previous COCs users (from 3.9±1.0 to 2.9±0.8; p<.001) and nonusers (from 3.2±0.9 to 2.6±1.3; p<.02) following 6 months of POP use in comparison with the run-in period. Duration of headache pain did not differ significantly in both groups throughout the study. Interestingly enough, a beneficial POP effect on the duration (mean±S.D.) of visual aura (from 16.3±9.5 to 11.4±5.6 min) and on the total duration (mean±S.D.) of neurological symptoms (from 33.6±23.3 to 18.6±18.0 min) was only significantly reported by previous COCs users (p<.001, for both) by the end of the study period. The POP was well tolerated by each woman and the bleeding pattern was variable with a tendency towards infrequent bleeding.
  
  
  CONCLUSIONS
  The present study supports the use of the POP containing desogestrel in a population of women with MA and underlines a positive effect on symptoms of aura, especially in MA sensitive to previous use of COCs.
authors.affiliation: Research Center for Reproductive Medicine, Department of Morphological, Eidological and Clinical Sciences, Pavia, Italy. renappi@tin.it
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.forename: Grazia
authors.initials: G
authors.lastname: Sances
authors.forename: Gianni
authors.initials: G
authors.lastname: Allais
authors.forename: Erica
authors.initials: E
authors.lastname: Terreno
authors.forename: Chiara
authors.initials: C
authors.lastname: Benedetto
authors.forename: Valentina
authors.initials: V
authors.lastname: Vaccaro
authors.forename: Franco
authors.initials: F
authors.lastname: Polatti
authors.forename: Fabio
authors.initials: F
authors.lastname: Facchinetti
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003267:Contraception / Q000379:methods*; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D017135:Desogestrel / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D020325:Migraine with Aura / Q000503:physiopathology*; D010865:Pilot Projects; D011372:Progestins / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D003276:Contraceptives, Oral; D011372:Progestins; D017135:Desogestrel