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