Effect of desogestrel 75 µg on headache frequency and intensity in women with migraine: a prospective controlled trial

Abstract

Objective: In contrast with combined hormonal contraception, progestin-only contraception is not associated with an increase in venous thromboembolism or stroke. Women with migraine are at increased risk of ischaemic stroke. Several studies have reported a reduction in migraine frequency and intensity with desogestrel 75 µg, a progestin-only pill. At present the quality of data is limited by retrospective study designs, lack of control groups and small sample sizes. We present the first prospective nonrandomised controlled trial.

Methods: A total of 150 women with migraine visiting our clinic for contraceptive counselling were screened. The intervention group comprised women who opted for contraception with desogestrel (n = 98); the control group comprised women who continued their usual contraceptive (n = 36). Participants completed daily diaries for 90 days before the intervention and 180 days after the intervention.

Results: In the intervention group, we found improvements in migraine frequency (p < .001), migraine intensity (p < .001) and the number of triptans used (p < .001). These improvements were already significant after 90 days of desogestrel use (p < .001). Disability scores also decreased significantly. No improvement was seen in the nonintervention group.

Conclusion: These data demonstrate for the first time in a prospective controlled setting that daily use of the progestin desogestrel is associated with a decrease in migraine frequency, migraine intensity and pain medication use in women with migraine, with and without aura, who had previously been experiencing at least three days of migraine per month.

Trial registration: The study is registered in the University of Zürich database (www.research-projects.uzh.ch/unizh.htm).

摘要

目的：与联合激素避孕药相比, 单纯孕激素避孕与静脉血栓栓塞或中风发生风险的增加无关。患有偏头痛的女性发生缺血性中风的风险增加。一些研究报道, 服用75mg的去氧孕烯（一种仅含孕激素的药片）可减少偏头痛的频率和强度。目前, 数据的质量受到回顾性研究设计、缺乏对照组和样本量少的限制, 我们提出了第一个前瞻性非随机性对照试验。

方法：共筛选了150名到我们门诊进行避孕咨询的患有偏头痛的女性, 干预组包括选择服用去氧孕烯避孕的女性（n = 98）, 对照组包括继续采用常规避孕药具的女性（n = 36）。参与者在干预前和干预180天后完成每日日记90天。

结果：在干预组中, 我们发现偏头痛频率（p <0.001）、偏头痛强度（p <0.001）和服用曲普坦类的药物数量（p <0.001）有所改善。服用去氧孕烯90天后, 以上已经显著改善（p <0.001）, 残疾分数也显著下降, 非干预组没有看到改善。

结论：这些数据首次证明, 在一项前瞻性对照环境中, 去氧孕烯的每日服用与偏头痛患者的偏头痛发作频率、强度和止痛药服用率降低有关。偏头痛患者要求有或没有先兆, 曾经历过每月至少3天的偏头痛。

临床试验注册：该研究在苏黎世大学数据库（www.research-projects. uzh.ch/unizh.htm）注册。

Keywords:

• Combined oral contraceptive pill
• contraception
• desogestrel
• estrogen-withdrawal headache
• migraine prevention
• migraine without aura
• triptans

Acknowledgement

We thank all the study participants.

Disclosure statement

No conflicts of interest are reported by ARG, BI and PS.