J Headache Pain. 2013 Aug 1;14(1):66. doi: 10.1186/1129-2377-14-66.
A significant number of women with migraine has to face the choice of reliable hormonal contraception during their fertile life. Combined hormonal contraceptives (CHCs) may be used in the majority of women with headache and migraine. However, they carry a small, but significant vascular risk, especially in migraine with aura (MA) and, eventually in migraine without aura (MO) with additional risk factors for stroke (smoking, hypertension, diabetes, hyperlipidemia and thrombophilia, age over 35 years). Guidelines recommend progestogen-only contraception as an alternative safer option because it does not seem to be associated with an increased risk of venous thromboembolism (VTE) and ischemic stroke. Potentially, the maintenance of stable estrogen level by the administration of progestins in ovulation inhibiting dosages may have a positive influence of nociceptive threshold in women with migraine. Preliminary evidences based on headache diaries in migraineurs suggest that the progestin-only pill containing desogestrel 75μg has a positive effect on the course of both MA and MO in the majority of women, reducing the number of days with migraine, the number of analgesics and the intensity of associated symptoms. Further prospective trials have to be performed to confirm that progestogen-only contraception may be a better option for the management of both migraine and birth control. Differences between MA and MO should also be taken into account in further studies.
相当数量的偏头痛女性在生育期必须面对可靠的激素避孕选择。大多数头痛和偏头痛患者都可以使用复方激素避孕药（CHC）。然而，它们存在着较小但显著的血管风险，尤其是在有先兆偏头痛（MA）和有额外中风危险因素的无先兆偏头痛（MO）中（吸烟、高血压、糖尿病、高脂血症和血栓形成倾向、年龄超过 35 岁）。指南建议孕激素避孕药作为一种更安全的替代选择，因为它似乎与静脉血栓栓塞（VTE）和缺血性中风的风险增加无关。孕激素以排卵抑制剂量给药可能会维持稳定的雌激素水平，从而对偏头痛女性的伤害性阈值产生积极影响。基于偏头痛患者头痛日记的初步证据表明，含有去氧孕烯 75μg 的孕激素避孕药对大多数女性的 MA 和 MO 病程均有积极影响，减少偏头痛天数、镇痛药用量和相关症状的强度。需要进一步进行前瞻性试验来证实孕激素避孕药可能是管理偏头痛和避孕的更好选择。在进一步的研究中，也应该考虑 MA 和 MO 之间的差异。
