Hormonal contraceptives in a migraine: threats and opportunities, market growth
Tuesday, 05 February, 2019
It is a significant moment for migraine treatment because manufacturers have new drugs for the prevention of acute attacks. First of all newly manufactured drugs, erenumab, is already available in the USA and hopefully it will soon become available in other countries. Other drugs such as fremanezumab, galcanezumab and eptinezumab are on the way.
The new drugs are monoclonal antibodies which act on the calcitonin gene-related peptide pathway. Existing studies specified that those drugs are providing a good result for migraine prevention. Moreover, they have a good acceptability profile and helpfulness because they can be directed via subcutaneous injections once a month or even quarterly.
“The shortcoming of the new drugs is represented by the costs which will be high limiting the number of patients who will benefit from them.”
A migraine mostly affects women in their reproductive age and the issue of hormonal contraception in women with a migraine is very common in daily clinical practice. A group of experts in a headache, hormonal contraception, and stroke developed two consensus documents on the use of hormonal contraception in women with a migraine. The documents were supported by the European Headache Federation (EHF) and the European Society of Hormonal Contraception and Reproductive Health.
There are the headache specialists who treat migraine patients but on other hands who do not have sufficient knowledge of the benefits and harms of all the probable contraceptive options. On the other side, we have the gynecologists who know hormonal contraceptives but may pay not enough attention to the presence of a migraine.
The first consensus article was about safety as the use of hormonal contraceptive containing estrogens increases the risk of ischemic stroke in women with a migraine and especially in those with migraine with aura.
The second consensus article was about the impact of exogenous sex hormones on the course of a migraine. These examples point out the two main points of documents: safe use of hormonal contraception in women with a migraine and impact of hormones on the course of a migraine. Applying the guidelines, we can avoid ischemic stroke, improve a migraine, and prevent worsening related to the use of hormonal contraception.
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