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Oral contraceptives in migraine therapy

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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.

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Abbreviations

COCs:

Combined oral contraceptives

HFI:

Hormone-free interval

OCMM:

Oral contraceptive-induced menstrual migraine

POP:

Progestogen-only pill

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Conflict of interest

The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Women’s Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy

    Gianni Allais, Ilaria Castagnoli Gabellari, Cristina De Lorenzo, Ornella Mana & Chiara Benedetto

Authors
  1. Gianni Allais
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  2. Ilaria Castagnoli Gabellari
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  3. Cristina De Lorenzo
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  4. Ornella Mana
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  5. Chiara Benedetto
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Correspondence to Gianni Allais.

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Allais, G., Castagnoli Gabellari, I., De Lorenzo, C. et al. Oral contraceptives in migraine therapy. Neurol Sci 32 (Suppl 1), 135–139 (2011). https://doi.org/10.1007/s10072-011-0538-z

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