Department of Gynecology and Obstetrics, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
Neurol Sci. 2011 May;32 Suppl 1:S135-9. doi: 10.1007/s10072-011-0538-z.
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.
即使有时复方口服避孕药（COC）会引发或加重头痛，特别是偏头痛，但在 COC 使用的头几个月后，头痛通常会有所改善。如果偏头痛持续存在，在许多患者中，发作更可能发生在无药丸的一周期间，并且发生与口服避孕药相关的月经性偏头痛（OCMM）。在 OCMM 的情况下，可以通过消除或减少无激素间隔（HFI）来进行一些激素处理，以预防这种雌激素撤退性头痛。可以使用连续的 COC 方案，将 HFI 缩短至传统的 7 天以下，在 COC 21 天后使用低剂量雌激素补充剂，或开具孕激素仅避孕药（POP）。有趣的是，POP 的使用对于患有偏头痛伴先兆（COC 绝对禁忌）的女性也是一种安全的选择，最近的一项试验表明，其使用也可以减少偏头痛发作的频率和先兆症状的持续时间。
