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 μg 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 μg/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.