title: Oral contraceptives in migraine therapy.
abstract: Even if sometimes combined oral contraceptives (COCs) can initiate or aggravate headaches, in particular migraine, the headaches generally tend to improve after the first months of COC use. If migraine persists, in many patients the attacks are more likely to occur during the pill-free week, and an oral contraceptive-induced menstrual migraine (OCMM) occurs. In case of OCMM, some hormonal manipulations are available, by eliminating or reducing the hormone-free interval (HFI), in order to prevent this estrogen-withdrawal headache. It is possible to use a continuous COCs regimen, to shorten the HFI to less than the traditional 7 days, to use a low-dose estrogen supplementation after the 21 days of COCs or to prescribe a progestogen-only pill (POP). Interestingly, the use of a POP is a safe option also for women suffering from migraine with aura (in which COCs are absolutely contraindicated) and a recent trial suggests that its use can reduce the frequency of migraine attacks and the duration of aura symptoms too.
authors.affiliation: Department of Gynecology and Obstetrics, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy. gb.allais@tiscali.it
authors.forename: Gianni
authors.initials: G
authors.lastname: Allais
authors.forename: Ilaria
authors.initials: I
authors.lastname: Castagnoli Gabellari
authors.forename: Cristina
authors.initials: C
authors.lastname: De Lorenzo
authors.forename: Ornella
authors.initials: O
authors.lastname: Mana
authors.forename: Chiara
authors.initials: C
authors.lastname: Benedetto
mesh_terms: D002986:Clinical Trials as Topic; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008881:Migraine Disorders / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D003278:Contraceptives, Oral, Hormonal