Although
combined oral contraceptives (COCs) are a safe and highly effective method of
birth control, they may also give rise to problems of clinical tolerability in
migraine patients. Indeed,
headache is among the most common side effects reported with the use of COCs, frequently leading to their being discontinued. The latest International Classification of
Headache Disorders identified at least two entities evidently related to the use of COCs, i.e., exogenous
hormone-induced
headache and
estrogen-withdrawal
headache. As to the former, the newest formulations of COCs are generally well tolerated by
migraine without aura patients, but can worsen
headache in
migraine with aura patients.
Headache associated with COCs, generally, tends to improve as their use continues. However, although it is not yet clear if there is an association between
headache and the composition of COCs (both in the type and amount of
hormones), it has been observed that the incidence of
headache during COC use seems greater if
migraine is associated with menstrual trigger. The
estrogen-withdrawal
headache is a
headache that generally appears within the first 5 days after cessation of
estrogen use and resolves within 3 days, even if in some cases it may appear on the sixth or seventh day after pill
suspension and lasts more than 3 days.