Effects of an estrogen-free, desogestrel-containing oral contraceptive in women with migraine with aura: a prospective diary-based pilot study |
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| Authors: | Nappi Rossella E Sances Grazia Allais Gianni Terreno Erica Benedetto Chiara Vaccaro Valentina Polatti Franco Facchinetti Fabio |
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| Affiliation: | aResearch Center for Reproductive Medicine, Department of Morphological, Eidological and Clinical Sciences, 27100 Pavia, Italy;bUnit of Gynecological Endocrinology and Menopause, Department of Internal Medicine and Endocrinology, IRCCS S. Maugeri Foundation, University of Pavia, Via Ferrata 8, 27100 Pavia, Italy;cUniversity Center of Adaptive Disorders and Headache (UCADH), University of Pavia, 27100 Pavia, Italy;dHeadache Centre, IRCCS “C. Mondino Foundation,” Department of Neurology, 27100 Pavia, Italy;eWomen's Headache Center, Department of Gynecol Obstet, University of Turin, 10100 Turin, Italy;fDepartment of Gynecol Obstet Pediat Sciences, University of Modena and Reggio Emilia, 4100 Modena, Italy |
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| Abstract: | BackgroundMigraine 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.Study DesignProspective 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.ResultsThe 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.ConclusionsThe 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. |
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| Keywords: | Progestogen-only pill (POP) Migraine with aura Desogestrel Estrogen-free contraception Headache diary |
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