1 Timaru Hospital, Timaru, Canterbury, New Zealand.
2 St Vincent's Hospital, Darlinghurst, Sydney, Australia.
Cephalalgia. 2018 Apr;38(4):754-764. doi: 10.1177/0333102417710636. Epub 2017 May 29.
Background Migraine is highly prevalent in women (18%). Peak morbidity affects their most productive years, coinciding with peak fertility. Hormonal contraception is often tailored for migraine prevention. Estrogen-containing contraceptives may be contraindicated in women experiencing migraine with aura due to the risk of vascular events. While improvements in migraine with a progestin-only pill (POP), which inhibits ovulation are documented, the strength and quality of evidence has not been formally evaluated. Objectives To determine the effectiveness of progestin-only contraceptives for migraine treatment by systematic review and meta-analysis. Data sources and selection MEDLINE, EMBASE and Cochrane Libraries were searched (1980 to September 2016) for studies on progestin-only treatments for migraine. Studies in English on >4 non-menopausal women aged 18-50 with migraine diagnosed by formal criteria were included. Data extraction and analysis Data were quality-assessed using the GRADE system. A random effects model was used for pooled analyses. Results Pooled analyses of four studies demonstrated that desogestrel 75 mcg/day, POP significantly but modestly reduced the number of migraine attacks and migraine days. Reduced intensity and duration, reduced analgesic and triptan use were observed, along with improved headache-related quality of life. GRADE analysis indicated evidence was low to very low for each outcome measure. Adverse effects resulted in treatment cessation for <10% of participants. Two studies compared desogestrel POP to a combined oral contraceptive, demonstrating similar migraine outcomes for both treatments. Conclusions The desogestrel POP shows promise in improving migraine in women. Current evidence is observational and based on small samples of women using only one oral progestin-only formulation. Further randomized trials on additional progestin-only contraceptives are required to confirm their role in migraine management.
偏头痛在女性中（18%）高发。发病高峰期影响了她们生产力最高的年龄段，而这一阶段同时也是生育高峰期。激素避孕常常被用于偏头痛的预防。含有雌激素的避孕药可能会由于血管事件的风险而对伴有先兆偏头痛的女性禁用。虽然孕激素避孕药（POP）的使用可以改善偏头痛，因为其抑制排卵，但该方法的有效性和质量证据尚未得到正式评估。目的：通过系统评价和荟萃分析来确定孕激素避孕药治疗偏头痛的效果。
对 MEDLINE、EMBASE 和 Cochrane 图书馆进行了检索（1980 年至 2016 年 9 月），寻找孕激素治疗偏头痛的研究。纳入了研究对象为>4 名年龄在 18-50 岁之间的非绝经期女性，且偏头痛的诊断采用了正式标准。
使用 GRADE 系统对数据质量进行评估。采用随机效应模型进行汇总分析。
四项研究的汇总分析表明，地诺孕素 75μg/天，POP 可显著但适度地减少偏头痛发作次数和偏头痛天数。同时观察到疼痛强度和持续时间降低、镇痛药和曲坦类药物使用减少以及头痛相关生活质量改善。GRADE 分析表明，每个结局测量的证据为低到极低。不良反应导致<10%的参与者停止治疗。两项研究比较了地诺孕素 POP 与复方口服避孕药，两种治疗方法的偏头痛结局相似。
地诺孕素 POP 在改善女性偏头痛方面有一定效果。现有证据为观察性证据，基于使用单一孕激素避孕药的小样本女性。需要进一步开展关于其他孕激素避孕药的随机试验来证实其在偏头痛管理中的作用。
