Department Obstetric and Gynecology, University of Pavia, Italy.
Contraception. 2013 Sep;88(3):369-75. doi: 10.1016/j.contraception.2013.02.001. Epub 2013 Feb 28.
Combined hormonal contraception might worsen migraine in sensitive women, especially during the free-hormone interval, and raise concerns about the vascular risk. The characteristics of a contraceptive pill containing estradiol valerate/dienogest (E2V/DNG) might be of potential benefit in women with menstrually related migraine (MRM) who choose to use oral contraception for birth control.
This was a prospective diary-based pilot study. Thirty-two women (age >35 years) [n=18 who had never used combined oral contraceptives (COCs) and n=14 who had previously used COCs] diagnosed with MRMs according to the International Headache Society criteria were included. During the observational period, women filled in a diary with the clinical characteristics of migraine attacks. After a three-cycle run-in period, each subject received a COC containing E2V/DNG (Qlaira®/Natazia®; Bayer HealthCare, Berlin, Germany) administered using an estrogen step-down and progestogen step-up approach. Follow-up evaluations were scheduled at the last cycle of run-in and at the third and sixth cycles of treatment.
The number of migraine attacks was significantly reduced at the third (p<.001) and sixth cycles (p<.001) in comparison with the run-in period. A similar result was evident for the duration (p<.001 at the third and p<.001 at the sixth cycle) as well as for the severity of head pain (p<.001 at the third and p<.001 at the sixth month). Indeed, a significantly lower number of analgesics were used at the third cycle (p<.001) in comparison with baseline, and a further decrease was evident at the sixth cycle (p<.001) in comparison with the third cycle of E2V/DNG use. Interestingly, duration and severity of head pain were significantly correlated with the number of days of dysmenorrhea at the third cycle (r=.89, p=.000 and r=.67, p=.02; respectively) and at the sixth cycle (r=.76, p=.000 and r=.62, p=.04; respectively) in women without complete remission of menstrual cramps during the study period.
The present diary-based pilot study indicates that the use of a pill containing EV2/DNG for six cycles has a positive effect in women with MRM and suggests an association between dysmenorrhea with COCs use as a potential feature of refractory head pain.
联合激素避孕可能会使敏感女性的偏头痛恶化，尤其是在无激素间隔期间，并引发对血管风险的担忧。含有雌二醇戊酸酯/地诺孕素（E2V/DNG）的避孕药的特点可能对选择使用口服避孕药控制生育的与月经相关的偏头痛（MRM）女性有益。
这是一项前瞻性基于日记的试点研究。32 名（年龄>35 岁）[从未使用过复方口服避孕药（COC）的 n=18 和之前使用过 COC 的 n=14]根据国际头痛协会标准诊断为 MRM 的女性被纳入研究。在观察期间，女性填写了偏头痛发作的临床特征日记。在三个周期的洗脱期后，每位受试者接受含有 E2V/DNG（Qlaira®/Natazia®；拜耳健康护理公司，柏林，德国）的 COC 治疗，采用雌激素逐渐减少和孕激素逐渐增加的方法。随访评估安排在洗脱期的最后一个周期以及治疗的第三个和第六个周期。
与洗脱期相比，第三个（p<.001）和第六个周期（p<.001）的偏头痛发作次数显著减少。持续时间（第三个和第六个周期均为 p<.001）和头痛严重程度（第三个和第六个周期均为 p<.001）也有类似的结果。事实上，与基线相比，第三个周期的镇痛药使用量显著减少（p<.001），并且在第六个周期（p<.001）与 E2V/DNG 使用的第三个周期相比进一步减少。有趣的是，在研究期间月经痛不完全缓解的女性中，头痛的持续时间和严重程度与第三个周期（r=.89，p=.000 和 r=.67，p=.02）和第六个周期（r=.76，p=.000 和 r=.62，p=.04）的痛经天数显著相关。
本基于日记的试点研究表明，使用含有 EV2/DNG 的避孕药六个周期对 MRM 女性有积极影响，并提示痛经与 COC 使用之间存在关联，这可能是难治性头痛的一个特征。
