The author replies [concerning headache and the pill] [letter]
I appreciate your comments. The study period was from 1964-1980. During this time the dose of both estrogens and progesterones in oral contraceptives (OCs) was reduced from the initial high dose combined tablet (exemplified by Ortho Novum 10) to the current mini-pill. Since the pill was prescribed by others I accepted this variation in dosage which made no difference in the results. The diagnosis was made on the clinical accentuation of vascular headache while the patient was taking the pill and its relief or marked reduction when she stopped taking it. The controls were given samples of Ortho Novum 10 a high-dose pill and Ortho Novum Sequential kindly supplied by Ortho Pharmaceutical (Canada) Ltd. As reported no vascular headache developed when patients used the high dose pill. Although it is well recognized that cigarette smoking modifies peripheral vascular contractility the results in this study were obtained without changing smoking habits: 79% of the women seen smoked 25 cigarettes a day. Yearly sampling did not change this value significantly. Initially in the illustrative case most women of childbearing age (13-45 in this study) were taking the pill. By 1974 it was unusual for women over 30 to be taking it. This trend led to the collection of patients over 40 who were given estrogens (exemplified by Premarin) who also developed the vascular headache complex while taking the estrogen and were headache-free when they stopped. Throughout the study the majority of women taking the pill were in their late teens to mid-20s; those taking estrogen were in their mid-40s to late 50s. A detailed relationship to parity was not assessed. A review of the data before its presentation to the Canadian Congress of Neurological Sciences in June 1966 showed no change in the clinical picture in parous versus nulliparous women and this facet was not pursued further. I hope these comments clarify your questions. (full text)