ArticleThe journal of headache and pain2020
Migraine start, course and features over the cycle of combined hormonal contraceptive users with menstrual migraine - temporal relation to bleeding and hormone withdrawal: a prospective diary-based study.
Article in The journal of headache and pain, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 18 citations in OpenAlex.
- Hormonal Contraceptives and Migraine Frequency and Severity in Women: A Systematic Review and Meta-Analysis.Cureus · 2026Review
- Prevalence of migraine subtypes in women with endometriosis and/or dysmenorrhea: results from a cross-sectional multicenter trial.BMC women's health · 2026Article
- Inhibition of the METTL3/mThe journal of headache and pain · 2025Article
- Lasmiditan and Different Triptans in Menstrual Migraine: A Bayesian Network Meta-analysis.Pain and therapy · 2025Review
- Assessing the association between age at first sexual intercourse and migraine: a Mendelian randomization study.Frontiers in neurology · 2024Article
- Clinical features of migraine with onset prior to or during start of combined hormonal contraception: a prospective cohort study.Acta neurologica Belgica · 2022Article
- Article
- Hormonal influences in migraine - interactions of oestrogen, oxytocin and CGRP.Nature reviews. Neurology · 2021Review
- Understanding migraine throughout a woman's life and the role of calcitonin gene-related peptide: A narrative review.Women's health (London, England)Review
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4 authors at 2 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundMany studies have described the features of menstrually-related migraines (MRM) in the natural cycle and the efficacy of prevention. MRM in combined hormonal contraceptive (CHC) users has scarcely been researched. Estrogen and progestin withdrawal in CHC users are both more abrupt and from higher hormone levels compared with the natural cycle. An advantage for prevention of MRM in CHC users is that the hormone withdrawal is predictable. It is unknown, whether the attacks during the hormone-free interval are associated with the hormone withdrawal or onset of bleeding. Improved understanding of this relation might contribute to better define and shorten the time interval for prevention.
methodsFor this prospective diary-based trial we collected migraine and bleeding data from CHC users with MRM in at least two of three cycles. We analyzed frequency of migraines over the whole CHC cycle. During the hormone-free phase the relation between onset of migraine and onset of bleeding was studied. We compared pain intensity and identified prolonged-migraine attacks during hormone use and the hormone-free phase.
resultsDuring the hormone-free interval the number of migraine days and the pain score/migraine day were significantly higher in comparison with the mean during hormone use. The prevalence of migraine attacks was fourfold on hormone-free days 3-6. Migraine typically started on days 1-4. Migraine in relation to bleeding mostly occurred on days - 1 to + 4. In 78% of the cycles the first migraine day occurred during bleeding days 1 ± 2 and 48% started on days - 1 and day 1. The predictability of the first bleeding day was very high.
conclusionThe day of hormone-withdrawal migraine and the first bleeding day are highly predictable in CHC users. Migraine onset is mostly day - 1 and 1 of the bleeding and on days 1-4 of the hormone-free interval. Migraine attacks of CHC users in the hormone-free interval are severe and long lasting. Further trials are necessary to investigate if this knowledge can be used to optimise prevention.
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