Progestin-only contraception compared with extended combined oral contraceptive in women with migraine without aura: a retrospective pilot study Matteo Morotti *, Valentino Remorgida, Pier Luigi Venturini, Simone Ferrero Department of Obstetrics and Gynecology, IRCCS Azienda Ospedaliera Universitaria San Martino—IST Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 1, Genoa, Italy Introduction Migraine is a common neurological disorder, affecting about 18% of women in US and Europe, and it is more common during the reproductive years [1]. Women of reproductive age often request hormonal contraception for fertility purposes. In addition some of them can suffer gynecological conditions that are comorbid with migraine (such as endometriosis) that can be treated with combined hormonal contraception (CHC). This enhances the likelihood of CHC use in the migrainous population [2,3]. As hormonal fluctuations are thought to likely play a role in migraine pathophysiology, and estrogen withdrawal is probably one of the more important triggers, several studies have tried to optimize hormonal treatment in women with migraine without aura (MO) who desire hormonal contraception [4–7]. The rationale of these studies was to eliminate or minimize premenstrual estrogen withdrawal and thus maintain steady estrogen levels [8]. Continu- ous strategies include CHC consumption in extended-cycle regi- mens, where the placebo week is eliminated for extended periods, often for 12 weeks or more. These strategies also include the use of a continuous vaginal-ring contraceptive or an estradiol patch or combined oral contraceptives (COCs) which contain ethinylestradiol and a synthetic progestin. Sulak et al. reported the efficacy of extended dosing with a 30-mg ethinylestradiol COC in reducing menstrual headache in a 6-month open-label trial [5]. For this reason extended contraception has been widely used in patients with MO desiring hormonal therapy. However, both migraine with aura and MO can increase vascular risk, especially the risk of stroke in younger women [9,10]. This risk may further increase when CHCs are used [11–13]. The cardiovas- cular risk of CHCs is mainly attributed to the estrogen component, which exerts a strong effect on the coagulation system [12,13]. European Journal of Obstetrics & Gynecology and Reproductive Biology 183 (2014) 178–182 A R T I C L E I N F O Article history: Received 28 May 2014 Received in revised form 8 October 2014 Accepted 22 October 2014 Keywords: Combined oral contraceptive Desogestrel-only pill Headache Migraine without aura Pain Progestins A B S T R A C T Objective: To evaluate the effect of a desogestrel progestogen-only pill (POP) compared to continuous combined oral contraception (COC) on migraine patterns in women with migraine without aura. Study design: A retrospective analysis of prospective headache charts from migrainous women who used the POP or COC in our clinic between July 2009 and July 2013. The quality and quantity of migraine attacks and use of medications were evaluated at three and six months. Health related quality of life was evaluated after 6 months’ treatment. Results: Fifty-three patients were evaluable for the analysis (22 in the COC group and 31 in the POP group). Six months’ POP treatment led to a statistical reduction in migraine days; headache days; pain intensity; number of days with severe pain and days with pain medication. The only statistical difference between the two groups was a reduction in the number of days with pain medication in the POP group compared to the COC group (p = 0.044). After 6 months’ treatment a quality of life improvement was seen only in the POP group, but no statistical differences were found when comparing the two groups. Conclusions: Our preliminary data confirm that POP therapy improves migraine patterns and quality of life after 6 months’ treatment in women with migraine without aura and it decreases the analgesic consumption with respect to an extended COC therapy. As POP represents a healthier opportunity, in terms of vascular risk, than combined contraception, its role in migrainous women deserves to be further investigated. ß 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +39 010511525; fax: +39 010511525.. E-mail address: drmorottimatteo@gmail.com (M. Morotti). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology jou r nal h o mep ag e: w ww .elsevier .co m /loc ate/ejo g rb http://dx.doi.org/10.1016/j.ejogrb.2014.10.029 0301-2115/ß 2014 Elsevier Ireland Ltd. All rights reserved.