NEW YORK (Reuters Health) – Women with pure menstrual migraines without aura will experience greater symptom relief with a combined oral contraceptive (COC) regimen that includes four placebo pills per cycle, rather than the standard seven, new research shows.
“The use of a 24/4 regimen, with a shortened 4-day pill-free interval, and with a progestin such as drospirenone, should be the regimen of choice for women suffering from menstrual migraines,” Dr. Vincenzo De Leo of the University of Siena in Italy and his colleagues conclude in an August 16 online publication in Fertility and Sterility.
Seventeen percent of US women suffer from migraines, while 60 percent of these women say their migraines are more likely to occur during menstruation. A smaller percentage of female migraineurs (estimates range from about 4 percent to about 20 percent) have pure menstrual migraines.
Pure menstrual migraines occur on the first day of menstruation, or two days before or after the menstrual cycle begins, for at least two of every three cycles, and do not occur at other points in the menstrual cycle, Dr. De Leo and his colleagues explain in their report. Women are said to have menstruation-related migraines if they have up to 4 migraines per month, one of which occurs during or directly before menstruation, on at least two out of three cycles.
Migraine sufferers who use COC are more likely to have migraines on the days when they take placebo pills, according to the researchers. Research suggests pills containing the spironolactone-derived progestin drospirenone may improve premenstrual symptoms, they add, but their effects on menstrual migraines have not been specifically studied.
To investigate, Dr. De Leo and his team randomly assigned 60 women with pure menstrual migraine to one of two different regimens of ethinyl E2/drospirenone for three months. Group A took 21 active pills followed by 7 placebo pills, while Group B took 24 active pills and 4 placebo pills.
Women in both groups rated their headache intensity at 2.7 (Group B) or 2.8 (Group A) on a scale of zero to three at the study’s outset, while the average number of days per month with migraine was three for both groups.
Both groups reported having less intense migraines, and shorter migraine duration, but the reduction among Group B patients was significantly greater than in Group A, the researchers found. At month three, women in Group A rated their pain intensity at about 1.4, on average, while Group B rated their average pain intensity at about 1. Women in Group A averaged about 1.4 days of migraine during month three, compared to one day for Group B. None of the patients reported side effects, and compliance was “excellent,” according to the researchers.
They conclude: “The 24/4 COC regimen is recommended as the preferred treatment for patients suffering from pure menstrual migraine without aura.”
Reference:
Combined oral contraceptives in women with menstrual migraine without aura
Fertility and Sterility, online August 16, 2011.
