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Table 5 Recommendations on the use of estrogens and progestogens in women of reproductive age with migraine considering their effect on migraine course

From: Effect of exogenous estrogens and progestogens on the course of migraine during reproductive age: a consensus statement by the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESCRH)

Treatment Population Recommendation Quality of Evidence Strength of Recommendation Comments
21/7 combined contraceptive regimen with oral pill or patch* Women with migraine who require hormonal contraception Not suggested None Weak Alternative contraceptive strategies are more convenient in migraineurs
Desogestrel-only 75 μg/day pill Women with migraine, related or unrelated to menstruation, who require treatment for contraception or medical reasons Suggested Low Weak No evidence available for progestogen only-pills other than desogestrel 75 μg/day
Women with estrogen withdrawal headache or worsening of the usual headache with combined hormonal contraceptives; women with new onset migraine with combined hormonal contraceptives Suggested None Weak
Women with migraine, related to menstruation, who require migraine preventive treatments and who have contraindication or failure of conventional medical treatment Suggested None Weak
Women with migraine, related to menstruation, who have not tried migraine preventive drugs and who have no need of desogestrel-only pill for contraception or medical reasons Not suggested None Weak
Combined oral contraceptives with shortened pill-free interval* Women with migraine, related or unrelated to menstruation, who require treatment for contraception or medical reasons Not suggested Low Weak Data are too limited to support this option. No clear evidence that this may be better than conventional 21/7 regimen
Women with estrogen withdrawal headache Not suggested None Weak
Combined oral contraceptives with oral estradiol supplementation during the pill-free interval* Women with migraine, related or unrelated to menstruation, who require treatment for contraception or medical reasons Not suggested Low Weak Data are too limited to support this option. No clear evidence that this may be better than conventional 21/7 regimen. Alternative contraceptive strategies are more convenient in migraineurs
Women with estrogen withdrawal headache Not suggested None Weak
Combined oral contraceptives with estradiol supplementation with patch during the pill-free interval* Women with migraine, related or unrelated to menstruation, who require treatment for contraception or medical reasons Not suggested Low Weak Data are too limited to support this option. No clear evidence that this may be better than conventional 21/7 regimen
Alternative contraceptive strategies are more convenient in migraineurs
Women with estrogen withdrawal headache Not suggested None Weak
Extended regimen of combined hormonal contraceptives with pill or patches* Women with migraine, related or unrelated to menstruation, who require treatment for contraception or medical reasons Suggested Low Weak There is no clear evidence on the preferable extended regimen (oral pill and type of pill or patch) of combined contraceptives for women with migraine
Extended regimens of the contraceptive patch may be preferable over the 3 week patch + 1 patch-free week
Women with estrogen withdrawal headache Suggested None Weak
Women with migraine, related to menstruation, who require migraine preventive treatments and who have contraindication or failure of conventional medical treatment Suggested None Weak
Women with migraine, related to menstruation, who have not tried migraine preventive drugs and who have no need of desogestrel-only pill for contraception or medical reasons Not suggested None Weak
Combined hormonal contraceptive vaginal ring Women with migraine, related or unrelated to menstruation, who require treatment for contraception or medical reasons Suggested Low Weak  
Transdermal estradiol supplementation with estradiol gel Women with pure menstrual migraine Suggested Low Weak Patients should be informed that delayed migraine may occur and that treatment is potentially effective only on attacks related to menstruation
Women with menstrually-related migraine Suggested Low Weak
Women with estrogen-withdrawal headache Suggested None Weak
Transdermal estradiol supplementation with patch Women with pure menstrual migraine Not suggested Low Weak  
Women with menstrually-related migraine Not suggested Low Weak
Women with estrogen-withdrawal headache Not suggested Low Weak
Transdermal estradiol supplementation with patch in women induced in pharmacological menopause Women with migraine Not suggested Low Weak  
Subcutaneous estradiol; implant and cyclical progestogen Women with pure menstrual migraine Not suggested Low Weak  
Women with menstrually-related migraine Not suggested Low Weak
  1. *According to the Consensus Statement on the Safety of hormonal contraceptives in women with migraine, compounds containing estrogens are not suggested for women with migraine with aura and for women with migraine without aura and additional vascular risk factors [22]