Clinical features of migraine with onset prior to or during start of combined hormonal contraception: a prospective cohort study.

Abstract

Many studies have described the features of menstrually related migraines but there is a lack of knowledge regarding the features of migraine in combined hormonal contraceptive users (CHC). Hormone-withdrawal migraines in the pill-free period could differ from those in the natural cycle. Gynaecologic comorbidities, like dysmenorrhea and endometriosis, but also depression or a family history might modify the course of migraine. A better understanding of migraine features linked to special hormonal situations could improve treatment. For this prospective cohort study, we conducted telephone interviews with women using a CHC and reporting withdrawal migraine to collect information on migraine frequency, intensity, triggers, symptoms, pain medication, gynaecologic history and comorbidities (n\u2009=\u200948). A subset of women agreed to also document their migraines in prospective diaries. The mean number of migraine days per cycle was 4.2 (±\u20092.7). Around 50% of these migraines occurred during the hormone-free interval. Migraine frequency was significantly higher in women who suffered from migraine before CHC start (5.0\u2009±\u20093.1) (n\u2009=\u200922) in comparison to those with migraine onset after CHC start (3.5\u2009±\u20092.1) (n\u2009=\u200926). Menstrually related attacks were described as more painful (57.5%), especially in women with migraine onset before CHC use (72%) (p\u2009<\u20090.02). Comorbidities were rare, except dysmenorrhea. The majority of migraine attacks in CHC users occur during the hormone-free interval. Similar as in the natural cycle, hormone-withdrawal migraines in CHC users are very intense and the response to acute medication is less good, especially in those women, who developed migraine before CHC use.