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Contraceptive Vaginal Ring May Reduce Migraines

When treated with a low-dose of hormones from a contraceptive device, women with migraine with aura and menstrual-related migraine experienced significant improvement in both disorders.

These results in a recent study bring potentially good news for many women, but the lead author of the study, Anne Calhoun, MD, of the University of North Carolina in Chapel Hill, tempered her enthusiasm.

“I first urge caution,” she told Reuters Health, stressing that the study was small—just 23 subjects—and intended to guide future research. “Good science requires larger and more rigorous trials before definitive conclusions can be gained.”

Medical guidelines say that women with migraine with aura should not use combined hormonal contraceptives because these pharmaceuticals might increase the risk of stroke, which is already heightened among migrainuers with aura. Stroke risk is linked to aura frequency, which in turn, has been linked to estrogen levels. But now some contraceptives exist that create lower estrogen levels for women than what they experience in their natural cycles. The authors believed that these contraceptives, because of the resulting lowered estrogen levels, should decrease migraine with aura as well as menstrual-related migraine.

In their study, a retrospective database review, researchers included women who had migraine with aura and menstrual-related migraine and had been treated with an extended-cycle dosing of a transvaginal ring with .120 mg etonogestrel/15 mcg ethinyl estradiol. The study began with 28 participants, but five stopped using the contraceptive device within the first month. The remaining participants averaged 3.23 migraine auras per month, and after nearly eight months of follow-up, their frequency had dropped to .23 per month. Additionally, the contraceptive had eliminated menstrual-related migraine in more than 91% of the participants.

While the study indicated that contraceptive hormones showed benefits for migraine, they cannot be interpreted to mean that they would also lower the risk of stroke for women who experience migraine with aura.

“This study is too small and of too short a duration to provide definitive answers,” the authors concluded. “But clearly, larger studies to evaluate this relationship are warranted.”

The study appeared in the journal Headache.

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