Consensus Statement: Estrogen and Progestogen Treatment for Migraines

More research is needed on the use of estrogens and progestogens and the effect they have on migraines in women of reproductive age, according to a literature review published in The Journal of Headache Pain.

International experts in the fields of migraines and hormonal contraception evaluated the current landscape of migraine management related to hormones and their withdrawal. They completed a literature search for retrospective, prospective, observational, and interventional studies involving estrogen or progestogen treatment for migraines in women of reproductive age. Data extraction on these studies included study design, cohort size, migraine type, treatments analyzed, and study outcomes.

The expert consensus consisted of a 3-round draft process where all experts reported thoughts, comments, and feedback of the document to the facilitator and the lead author, who then revised the consensus until an 80% agreement on the document was reached.

The review process found 21 studies involving the use of estrogens and progestogens on migraines in women. Overall, the data were very limited and weak. The oral desogestrel progestogen-only pill was associated with improvement in migraines with or without auras. Extended regimen of combined hormonal contraceptives showed some improvements over the conventional regimen. A study comparing the desogestrel progestogen-only pill and an extended regimen of combined hormonal contraceptives found preliminary evidence for a greater benefit from the desogestrel progestogen-only pill but not substantial proof.

Combined hormonal contraceptives with shortened pill-free intervals show some benefit to women who need the treatment for gynecological reasons, but there was little evidence to support this treatment for migraine pain management. The use of combined oral contraceptives with an estradiol patch supplementation showed no benefit to migraine relief.

A study evaluating the use of a combined hormonal contraceptive patch showed an association between hormone withdrawal and headaches but did not show migraine benefits. The combined hormonal contraceptive vaginal ring did not have enough data to provide support for treating migraines. Transdermal estradiol supplementation with gel showed some benefits, but the risk for delayed migraines did occur. Transdermal estradiol supplementation with a patch has limited results and is not considered a therapeutic option at this time, but it may be beneficial in women who are in perimenopause. Subcutaneous estrogen implant plus cyclical progestogen showed benefits in a pilot study, but further evaluation is needed to assess clinical outcomes.

Further research is needed to assess the relationship between estrogen and progestogens on migraines in women. At this time, all research is weak and very limited. The panel concluded that “[t]here is no evidence on how to manage women with headache attributed to the use of estrogens” at this time, but recommendations were made based on the current data available.

Multiple authors note an affiliation with the pharmaceutical industry. Please refer to original reference for a full list of authors’ disclosures.

Reference

Sacco S, Merki-Feld GS, Ægidius KL, et al. 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). J Headache Pain. 2018; 19(1):76. doi: 10.1186/s10194-018-0896-5