Background
Migraine is highly prevalent in women (18%). Peak morbidity affects their most productive years, coinciding with peak fertility.
Hormonal contraception is often tailored for
migraine prevention.
Estrogen-containing
contraceptives may be contraindicated in women experiencing
migraine with aura due to the risk of vascular events. While improvements in
migraine with a
progestin-only pill (POP), which inhibits ovulation are documented, the strength and quality of evidence has not been formally evaluated. Objectives To determine the effectiveness of
progestin-only
contraceptives for
migraine treatment by systematic review and meta-analysis. Data sources and selection MEDLINE, EMBASE and Cochrane Libraries were searched (1980 to September 2016) for studies on
progestin-only treatments for
migraine. Studies in English on >4 non-menopausal women aged 18-50 with
migraine diagnosed by formal criteria were included. Data extraction and analysis Data were quality-assessed using the GRADE system. A random effects model was used for pooled analyses. Results Pooled analyses of four studies demonstrated that
desogestrel 75 mcg/day, POP significantly but modestly reduced the number of
migraine attacks and
migraine days. Reduced intensity and duration, reduced
analgesic and
triptan use were observed, along with improved
headache-related quality of life. GRADE analysis indicated evidence was low to very low for each outcome measure. Adverse effects resulted in
treatment cessation for <10% of participants. Two studies compared
desogestrel POP to a
combined oral contraceptive, demonstrating similar
migraine outcomes for both treatments. Conclusions The
desogestrel POP shows promise in improving
migraine in women. Current evidence is observational and based on small samples of women using only one oral
progestin-only formulation. Further randomized trials on additional
progestin-only
contraceptives are required to confirm their role in
migraine management.