Combined hormonal contraceptives that can help prevent menstrual-related migraine
| Brand name | Generic alternatives | Dose | Clinical pearls |
|---|---|---|---|
| Continuous formulations | |||
| Lybrela | Ashlyna 28 Amethyst 28a | Ethinyl estradiol 20 µg and levonorgestrel 0.09 mg once daily for 365 days/year | Can substitute any generic 20-µg ethinyl estradiol pill and continue without placebo pills |
| NuvaRing | None (though many insurance plans cover it) | Vaginal ring Delivers ethinyl estradiol 15 µg and etonogestrel 0.12 mg daily Can be inserted once every 4 weeks to be used in a continuous fashion | Women who are sensitive to the drop in estrogen level in the last week may need to replace the ring every 3 weeks |
| Extended formulations | |||
| LoSeasonique | Amethia Lo Camrese Lo | Ethinyl estradiol 20 µg and levonorgestrel 0.1 mg for 84 days, then ethinyl estradiol 10 µg for 7 days | If a 30-µg ethinyl estradiol pill is used, will need to take it continuously to avoid triggering migraine |
| Monthly formulations | |||
| Lo Loestrin 1/10 | None | Ethinyl estradiol 10 µg and norethindrone 1 mg for 24 days, then ethinyl estradiol 10 µg for 2 days, then placebo for 2 days | Ultra-low doses may be associated with increased breakthrough bleeding; the bleeding can improve over time |
| Natazia | None | Estradiol valerate doses gradually decrease from 3 to 2 to 1 mg; dienogest dose increases from 2 to 3 mg | This pill pack has a different missed-pill algorithm; refer to package insert for specific instructions |
↵a Brand recently discontinued in the United States.