Migraine is a complex, disabling neurological condition characterized by recurrent episodes of headache. It affects up to 15 % of the adult population, whereby women of reproductive age are more frequently affected than men. Estrogens have been shown to play a pivotal role in migraine pathophysiology. Migraineurs are at increased for cerebral stroke and migraine is associated with an elevated risk for cardiovascular events. This risk has been shown to be especially high in migraine with aura. Contraception should not expose migraineurs to further health risks.
Contraception using gestagens
In contrast to combined hormonal contraceptives (CHC), progestin-only contraceptives (POC) are not associated with an elevated risk for ischemic attacks. Preliminary data even demonstrate the reduction of monthly migraine days, auras and use of analgetics with the use of desogestrel 75 μg.
CHC should only be used in exceptional cases. Migraine with aura is an absolute contraindication. Copper-releasing intrauterine devices do not affect the course of migraine. Hormone-withdrawal migraines can sometimes be successfully treated with use of CHC in a continuous regime. However, the affect of this therapy on the risk for ischemic attacks and ischemic stroke remains unclear; therefore, gestagens represent the preferred approach.