• Simona Sacco, Gabriele S Merki-Feld, Karen Lehrmann Ægidius, Johannes Bitzer, Marianne Canonico, Andreas R Gantenbein, Tobias Kurth, Christian Lampl, Øjvind Lidegaard, Anne MacGregor E E Centre for Neuroscience & Trauma, BICMS, Barts and the London School of Medicine and Dentistry, London, UK. , Antoinette MaassenVanDenBrink, Dimos-Dimitrios Mitsikostas, Rossella Elena Nappi, George Ntaios, Koen Paemeleire, Per Morten Sandset, Gisela Marie Terwindt, Kjersti Grøtta Vetvik, Paolo Martelletti, and European Headache Federation (EHF), the European Society of Contraception and Reproductive Health (ESCRH).
• Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy. simona.sacco@univaq.it.
• J Headache Pain. 2018 Aug 31; 19 (1): 76.

AbstractWe systematically reviewed data about the effect of exogenous estrogens and progestogens on the course of migraine during reproductive age. Thereafter a consensus procedure among international experts was undertaken to develop statements to support clinical decision making, in terms of possible effects on migraine course of exogenous estrogens and progestogens and on possible treatment of headache associated with the use or with the withdrawal of hormones. Overall, quality of current evidence is low. Recommendations are provided for all the compounds with available evidence including the conventional 21/7 combined hormonal contraception, the desogestrel only oral pill, combined oral contraceptives with shortened pill-free interval, combined oral contraceptives with estradiol supplementation during the pill-free interval, extended regimen of combined hormonal contraceptive with pill or patch, combined hormonal contraceptive vaginal ring, transdermal estradiol supplementation with gel, transdermal estradiol supplementation with patch, subcutaneous estrogen implant with cyclical oral progestogen. As the quality of available data is poor, further research is needed on this topic to improve the knowledge about the use of estrogens and progestogens in women with migraine. There is a need for better management of headaches related to the use of hormones or their withdrawal.

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