Combined oral contraceptives in women with menstrual migraine without aura

Objective: To compare the efficacy of two regimens (21 active pills + 7 placebo pills vs. 24 active pills + 4 placebo pills) of combined oral contraception (COC), both containing 20 mu g of ethinyl E-2 and 3 mg of drospirenone, in improving the severity of pure menstrual migraine without aura. Design: Prospective randomized study. Setting: Patients attending the gynecology department of the University of Siena for consultation regarding an appropriate contraception. Patient(s): Women ages 20 to 35 years (n = 60) suffering from pure menstrual migraine without aura. Intervention(s): Three months of contraceptive use (ethinyl E-2 20 mu g/drospirenone 3 mg) in two different regimens: group A received 21 active + 7 placebo pills whereas group B received 24 active + 4 placebo pills. Main Outcome Measure(s): Monthly evaluation of the duration and severity of patients' daily headache attacks. Result(s): Although both study groups demonstrated significant reduction in the intensity and duration of menstrual migraine, patients in group B (24/4 COC) reported a significant reduction in the intensity and a shorter duration of their menstrual migraine, compared with group A (21/7 COC). Conclusion(s): The 24/4 COC regimen is recommended as the preferred treatment for patients suffering from pure menstrual migraine without aura. (Fertil Steril (R) 2011; 96: 917-20. (C)2011 by American Society for Reproductive Medicine.)