Headache and Combination Estrogen-Progestin Oral Contraceptives:
Headache and Combination Estrogen-Progestin Oral Contraceptives:
Primary headache disorders such as migraine affect almost a third of women during their childbearing years, when decisions about contraception must be made. Headache is also a commonly reported adverse event in clinical trials of oral contraceptives (OCs). Health care practitioners will frequently be called upon to give advice about the use of OCs to women with headache. This article applies current evidence, guidelines, and recommendations about headache and OC use to treatment decisions in four clinical scenarios: initiating OC use in a woman who has migraine without aura, continuing OC use in a woman who experiences worsening of migraine and the development of aura after initiating OCs, initiating OC use in a woman with tension-type headache (TTH) and a family history of migraine, and use of an extended duration OC regimen to minimize migraine triggered by estrogen withdrawal. The authors' recommendations regarding OC use in various primary headache disorders are summarized.
Decisions to initiate or continue oral contraceptives (OCs) are influenced by both safety risks and nondangerous "nuisance" side effects. Headache is a side effect that is frequently mentioned as a reason not to begin or continue use of OCs. Because the background prevalence of headache is high in the population of women most likely to use OCs, it can be difficult to evaluate headache associated with OC use.
Combination OCs (COCs) are used by over 100 million women. Most OCs in use today contain between 20 and 50 (g (µg) of ethinyl estradiol and a progestin. Traditional 28-day combination regimens consist of active pills administered for 21 days, followed by 7 days of no tablets or placebo tablets. The doses of estrogen and progesterone can remain the same (monophasic) or vary (biphasic or triphasic). Doses of estrogen in OCs have decreased steadily over the years because lower doses of estrogen reduce the risk of thrombotic complications and do not decrease contraceptive efficacy.
In addition to being the most effective form of contraception, it is well established that OCs provide noncontraceptive benefits, including lowered risks of ovarian carcinoma, endometrial carcinoma, acute pelvic inflammatory disease, fibrocystic disease of the breast, ovarian cysts, ectopic pregnancy, menstrual disorders, and anemia. Several OC risks are also well established, especially stroke, venous thromboembolism, and cerebral venous thrombosis. Recently analyzed results from the Women's Health Initiative provide strong evidence that OC use decreases the risk of heart attack and high cholesterol. Current or former OC use does not appear to raise the risk of breast cancer.
Because both OC use and headache are common, physicians will frequently be asked to provide advice to women about their interaction. This article applies current evidence about headache and OC use to treatment decisions in four clinical scenarios: initiating OC use in a woman who has migraine without aura; continuing OC use in a woman who experiences worsening of migraine with aura; initiating OC use in a woman with tension-type headache (TTH); and use of an extended duration OC regimen to treat migraine triggered by estrogen withdrawal.
Abstract
Primary headache disorders such as migraine affect almost a third of women during their childbearing years, when decisions about contraception must be made. Headache is also a commonly reported adverse event in clinical trials of oral contraceptives (OCs). Health care practitioners will frequently be called upon to give advice about the use of OCs to women with headache. This article applies current evidence, guidelines, and recommendations about headache and OC use to treatment decisions in four clinical scenarios: initiating OC use in a woman who has migraine without aura, continuing OC use in a woman who experiences worsening of migraine and the development of aura after initiating OCs, initiating OC use in a woman with tension-type headache (TTH) and a family history of migraine, and use of an extended duration OC regimen to minimize migraine triggered by estrogen withdrawal. The authors' recommendations regarding OC use in various primary headache disorders are summarized.
Decisions to initiate or continue oral contraceptives (OCs) are influenced by both safety risks and nondangerous "nuisance" side effects. Headache is a side effect that is frequently mentioned as a reason not to begin or continue use of OCs. Because the background prevalence of headache is high in the population of women most likely to use OCs, it can be difficult to evaluate headache associated with OC use.
Combination OCs (COCs) are used by over 100 million women. Most OCs in use today contain between 20 and 50 (g (µg) of ethinyl estradiol and a progestin. Traditional 28-day combination regimens consist of active pills administered for 21 days, followed by 7 days of no tablets or placebo tablets. The doses of estrogen and progesterone can remain the same (monophasic) or vary (biphasic or triphasic). Doses of estrogen in OCs have decreased steadily over the years because lower doses of estrogen reduce the risk of thrombotic complications and do not decrease contraceptive efficacy.
In addition to being the most effective form of contraception, it is well established that OCs provide noncontraceptive benefits, including lowered risks of ovarian carcinoma, endometrial carcinoma, acute pelvic inflammatory disease, fibrocystic disease of the breast, ovarian cysts, ectopic pregnancy, menstrual disorders, and anemia. Several OC risks are also well established, especially stroke, venous thromboembolism, and cerebral venous thrombosis. Recently analyzed results from the Women's Health Initiative provide strong evidence that OC use decreases the risk of heart attack and high cholesterol. Current or former OC use does not appear to raise the risk of breast cancer.
Because both OC use and headache are common, physicians will frequently be asked to provide advice to women about their interaction. This article applies current evidence about headache and OC use to treatment decisions in four clinical scenarios: initiating OC use in a woman who has migraine without aura; continuing OC use in a woman who experiences worsening of migraine with aura; initiating OC use in a woman with tension-type headache (TTH); and use of an extended duration OC regimen to treat migraine triggered by estrogen withdrawal.
