The Role of Combined Hormonal Contraceptives in Migraine
The Role of Combined Hormonal Contraceptives in Migraine
A risk/benefit analysis of CHCs depends on who is looking. Neurologists may focus on their impact on migraine and stroke risk, whereas a gynecologist might be more concerned with effects on endometriosis and ovarian cancer risk. Yet, a patient's key concerns may be on contraceptive efficacy and acne.
Benefits of CHCs are evidence-based, established, and commonly applied in clinical practice. Compared with never users, CHC use for at least 5 years is associated with a 40% reduction in risk of ovarian cancer, a protective effect that increases to 80% risk reduction after 10 years of use. Similarly, CHC use reduces the risk of endometrial cancer by 50% with 5 years of use and by 80% after 10 years of use. For both malignancies, the risk reduction persists for at least 20 years.
Additionally, CHCs have been shown to decrease the risk of colorectal cancer and to improve endometriosis, menorrhagia, dysmenorrhea, premenstrual syndrome, anemia, hirsutism, pelvic inflammatory disease, and acne. The rate ratio for overall mortality is significantly lower for CHC users than for never users at 0.87 (0.79–0.96).
These are considerations commonly encountered in migraineurs. One study found that two thirds of subjects with MRM had one or more gynecologic comorbidities for which the preferred treatment was a CHC.
Finally, there is the cornerstone issue of MRM, arguably the most common disabling condition encountered in women's health. These attacks have proven to be more painful, of longer duration, and more resistant to therapy than those occurring elsewhere in the cycle. Amid reports of hormonal strategies that might potentially prevent these migraines, some headache specialists are revisiting the risk/benefit ratio of CHCs in migraineurs.
Non-contraceptive Benefits of CHCs
A risk/benefit analysis of CHCs depends on who is looking. Neurologists may focus on their impact on migraine and stroke risk, whereas a gynecologist might be more concerned with effects on endometriosis and ovarian cancer risk. Yet, a patient's key concerns may be on contraceptive efficacy and acne.
Benefits of CHCs are evidence-based, established, and commonly applied in clinical practice. Compared with never users, CHC use for at least 5 years is associated with a 40% reduction in risk of ovarian cancer, a protective effect that increases to 80% risk reduction after 10 years of use. Similarly, CHC use reduces the risk of endometrial cancer by 50% with 5 years of use and by 80% after 10 years of use. For both malignancies, the risk reduction persists for at least 20 years.
Additionally, CHCs have been shown to decrease the risk of colorectal cancer and to improve endometriosis, menorrhagia, dysmenorrhea, premenstrual syndrome, anemia, hirsutism, pelvic inflammatory disease, and acne. The rate ratio for overall mortality is significantly lower for CHC users than for never users at 0.87 (0.79–0.96).
These are considerations commonly encountered in migraineurs. One study found that two thirds of subjects with MRM had one or more gynecologic comorbidities for which the preferred treatment was a CHC.
Finally, there is the cornerstone issue of MRM, arguably the most common disabling condition encountered in women's health. These attacks have proven to be more painful, of longer duration, and more resistant to therapy than those occurring elsewhere in the cycle. Amid reports of hormonal strategies that might potentially prevent these migraines, some headache specialists are revisiting the risk/benefit ratio of CHCs in migraineurs.
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