MigrainePhase 3WHATTNCT04007874
Oral Contraceptive Pill Compared With Vitamin E in Women With Migraine
A Phase 3 study testing Ethinylestradiol/levonorgestrel and Vitamin E in people with Migraine and Migraine;Menstrual, run by Leiden University Medical Center at 1 site in Netherlands.
Trial summary
Open-label randomized controlled trial to study the efficacy of continuous daily use of ethinylestradiol/levonorgestrel (30/150 µg/day) compared with vitamin E (400 IU/day) in the treatment of women with menstrually-related and perimenopausal migraine. Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- Conditions the study is for
- Migraine, Migraine;Menstrual
- What is being tested?
- Ethinylestradiol/levonorgestrel and Vitamin E
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 360 participants
- Where
- 1 siteNetherlands
- Study dates
- 10 Sep 2019to Dec 2024
- Phase
- Phase 3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Female
- Premenopausal with menstrual migraine OR migraine during the early menopausal transition phase (a difference of 7 days or more in length of consecutive cycles, which should occur at least twice in a period of 12 menstrual cycles)
- Demonstrated at least 80% compliance with eDiary during baseline period
- No or stable for at least two months on prophylactic medication
Who cannot join
- Smoking
- Migraine with aura
- Chronic migraine with 15 or more headache days per month/with 8 or more migraine days per month
- Medication-overuse headache (ICHD-3 criteria)
- Women who are breastfeeding, pregnant, or planning to become pregnant
- Oral contraceptive use and not willing to undergo washout period (stop for two consecutive months)
Show all 17Show fewer
- Vitamin E use at start of the study
- Use of other sex hormone containing treatments
- Increased risk of VTE: history of VTE or thrombophlebitis, hereditary predisposition for VTE (APC resistance, protein C or S deficiency, antithrombin deficiency), VTE in first-degree family member at young age, long term immobilisation
- Increased risk of ATE: history of ATE, hereditary predisposition for ATE (hyperhomocysteinemia, antiphospholipid antibodies), ATE in first-degree family member at young age, diabetes mellitus, total cholesterol ≥ 6.5
- Other contraindication for oral contraceptives: liver malignancy, schistosomiasis, HIV/aids, use of immunosuppressives, tuberculosis, sex-hormone-dependent malignancies (breast, endometrial or ovary carcinomas), pancreatitis, vaginal bleeding with unknown cause, other diseases that can influence vessels (malignancies, heart valve disorders, atrial fibrillation, SLE, haemolytic uremic syndrome, chronic inflammatory bowel disease, sickle cell disease)
- Contraindication for vitamin E: vitamin K deficiency
- Hypersensitivity for any of the compounds in oral contraceptive or vitamin E
- Spontaneous postmenopausal status (menstrual bleedings have ceased for 12 consecutive months)
- Iatrogenic postmenopausal status
- Inability to complete the electronic diary in an accurate manner
- Any serious illness that can compromise study participation
Trial locations and contacts
1 site in 1 country.
Netherlands1 site, 1 recruiting
- Recruiting
Leiden University Medical Center
Leiden, South Holland, 2333 ZA
Britt WH van der Arend, MD, +31715266065, B.W.H.van_der_Arend@lumc.nl
About this study
Official title: Open-label Randomized Controlled Trial for the Effects of Continuous Ethinylestradiol/Levonorgestrel (30/150 μg/Day) Compared With Vitamin E (400 IU/Day) in the Treatment of Menstrually-related Migraine and Migraine During Perimenopause
Open-label randomized controlled trial to study the efficacy of continuous daily use of ethinylestradiol/levonorgestrel (30/150 µg/day) compared with vitamin E (400 IU/day) in the treatment of women with menstrually-related and perimenopausal migraine.
Read the detailed description
Rationale: The prevalence of migraine is three times higher in women than in men. Clinical and epidemiological studies suggest a prominent role for sex hormones in female migraine patients. Menstruation is an important factor increasing the susceptibility for an upcoming attack. Perimenstrual migraine attacks are also more disabling, longer lasting, and more difficult to treat than other attacks. Hormonal fluctuations during menopausal transition are associated with increased susceptibility for migraine as well, whereas hormonal changes in migraine during pregnancy seem to be associated with decreased attack frequency. Thus, sex hormonal conditions seem to affect the susceptibility for migraine attacks in women, but there is a lack of understanding the underlying pathophysiological mechanism. Currently, there is no clear evidence-based hormonal intervention for the treatment of migraine in women. The investigators hypothesize that continuous daily use of an oral contraceptive pill will be an effective, well-tolerated preventive treatment for 1) menstrually-related migraine and 2) perimenopausal migraine.
Objective: To study the efficacy of continuous daily use of ethinylestradiol/levonorgestrel (30/150 µg/day) compared with vitamin E (400 IU/day) in the treatment of menstrually-related and perimenopausal migraine.
Study design: Open-label randomized controlled trial. Study population: Women with menstrually-related or pure menstrual migraine and women with perimenopausal migraine.
Intervention: Continuous daily use of ethinylestradiol/levonorgestrel (30/150 µg/day) compared with vitamin E (400 IU/day).
Primary endpoint: Change in monthly migraine days from baseline to the last 4 weeks of treatment (weeks 9-12).
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The study will encompass a period of 4 months (1 baseline month and 3 treatment months). Patients have to fill out daily headache diaries throughout the study using a web-based app (≈ 5 min). Patients visit the headache clinic thrice, once for inclusion, once during the baseline period and once after 3 months of therapy (duration ≈ 1 hour). During the first and last visit blood samples will be taken. Patients will be contacted twice during follow-up to evaluate (S)AE's. Treatment with the oral contraceptive pill is accompanied by a very low risk of developing thromboembolisms. Participation might benefit participants by reducing their migraine attack frequency or intensity.
- Conditions
- Migraine, Migraine;Menstrual
- Being tested
- Ethinylestradiol/levonorgestrel, Vitamin E
- Keywords
- Migraine, Women, Hormones, Oral contraceptive pill, Vitamin E
- Medical subject headings
- Migraine Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Ethinylestradiol/levonorgestrelDrug
Also called Microgynon 30, RVG 08204
Ethinylestradiol/levonorgestrel 30/150 µg oral tablets once daily without a stopweek for 3 months
Vitamin EDrug
Vitamin E 400 IU oral capsules once daily for 3 months
| Study group | Role | What they receive |
|---|---|---|
| Ethinylestradiol/levonorgestrel | Experimental | Ethinylestradiol/levonorgestrel 30/150 µg oral tablets once daily without a stopweek for 3 months Receives: Drug: Ethinylestradiol/levonorgestrel |
| Vitamin E | Active comparator | Vitamin E 400 IU oral capsules once daily for 3 months Receives: Drug: Vitamin E |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of migraine days
Change in monthly migraine days
Measured: From baseline to the last 4 weeks of treatment (weeks 9-12)
Secondary outcomes (5)
Number of headache days
Change in monthly headache days
Measured: From baseline to the last 4 weeks of treatment (weeks 9-12)
Number of migraine attacks
Change in monthly migraine attacks
Measured: From baseline to the last 4 weeks of treatment (weeks 9-12)
Number of probable migraine attacks
Change in monthly probable migraine attacks
Measured: From baseline to the last 4 weeks of treatment (weeks 9-12)
Number of 50% responders
Patients who had ≥50% reduction in the number of migraine days
Measured: From baseline to the last 4 weeks of treatment (weeks 9-12)
(Serious) adverse events
Occurrence of adverse events and serious adverse events
Measured: Up to 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Jul 2019
- Study start10 Sep 2019
- Primary completionDec 2024 (estimated)
- Study completionDec 2024 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for MigraineStudies of the same condition, open and under way.
- More trials run by Leiden University Medical CenterThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Open-label randomized controlled trial
- Masking
- None (open label)
- Enrolment
- 360 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Leiden University Medical Center
- Sponsor type
- University, hospital or other
- Collaborators
- Erasmus Medical Center, Netherlands Brain Foundation, ZonMw: The Netherlands Organisation for Health Research and Development
- Responsible party
- Principal investigator, G.M. Terwindt, MD, Leiden University Medical Center
- Investigators
- Gisela M Terwindt, MD,PhD, Principal investigator, LUMC
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04007874
- Sponsor's protocol ID
- WHATT
- Other IDs
- 2018-004096-12, 2018
- Acronym
- WHATT
- Status last verified
- Dec 2023
- First submitted
- 28 Jun 2019
- Last updated
- 8 Dec 2023
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
van der Arend BWH, van Casteren DS, Verhagen IE, MaassenVanDenBrink A, Terwindt GM. Continuous combined oral contraceptive use versus vitamin E in the treatment of menstrual migraine: rationale and protocol of a randomized controlled trial (WHAT!). Trials. 2024 Feb 15;25(1):123. doi: 10.1186/s13063-024-07955-8.
PubMed 38360739
Study at a glance
From the registry record, last updated by the sponsor on 8 Dec 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Open-label Randomized Controlled Trial for the Effects of Continuous Ethinylestradiol/Levonorgestrel (30/150 μg/Day) Compared With Vitamin E (400 IU/Day) in the Treatment of Menstrually-related Migraine and Migraine During Perimenopause
- ClinicalTrials.gov ID
- NCT04007874
- Acronym / sponsor ID
- WHATT / WHATT
- Conditions
- Migraine, Migraine;Menstrual
- Keywords
- Migraine, Women, Hormones, Oral contraceptive pill, Vitamin E
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 360 participants (estimated)
- Lead sponsor
- Leiden University Medical CenterUniversity, hospital or other
- Collaborators
- Erasmus Medical Center, Netherlands Brain Foundation, ZonMw: The Netherlands Organisation for Health Research and Development
- Study start
- 10 Sep 2019 (actual)
- Primary completion
- Dec 2024 (estimated)
- Study completion
- Dec 2024 (estimated)
- First posted
- 5 Jul 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Open-label randomized controlled trial to study the efficacy of continuous daily use of ethinylestradiol/levonorgestrel (30/150 µg/day) compared with vitamin E (400 IU/day) in the treatment of women with menstrually-related and perimenopausal migraine.
Detailed description
Rationale: The prevalence of migraine is three times higher in women than in men. Clinical and epidemiological studies suggest a prominent role for sex hormones in female migraine patients. Menstruation is an important factor increasing the susceptibility for an upcoming attack. Perimenstrual migraine attacks are also more disabling, longer lasting, and more difficult to treat than other attacks. Hormonal fluctuations during menopausal transition are associated with increased susceptibility for migraine as well, whereas hormonal changes in migraine during pregnancy seem to be associated with decreased attack frequency. Thus, sex hormonal conditions seem to affect the susceptibility for migraine attacks in women, but there is a lack of understanding the underlying pathophysiological mechanism. Currently, there is no clear evidence-based hormonal intervention for the treatment of migraine in women. The investigators hypothesize that continuous daily use of an oral contraceptive pill will be an effective, well-tolerated preventive treatment for 1) menstrually-related migraine and 2) perimenopausal migraine.
Objective: To study the efficacy of continuous daily use of ethinylestradiol/levonorgestrel (30/150 µg/day) compared with vitamin E (400 IU/day) in the treatment of menstrually-related and perimenopausal migraine.
Study design: Open-label randomized controlled trial. Study population: Women with menstrually-related or pure menstrual migraine and women with perimenopausal migraine.
Intervention: Continuous daily use of ethinylestradiol/levonorgestrel (30/150 µg/day) compared with vitamin E (400 IU/day).
Primary endpoint: Change in monthly migraine days from baseline to the last 4 weeks of treatment (weeks 9-12).
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The study will encompass a period of 4 months (1 baseline month and 3 treatment months). Patients have to fill out daily headache diaries throughout the study using a web-based app (≈ 5 min). Patients visit the headache clinic thrice, once for inclusion, once during the baseline period and once after 3 months of therapy (duration ≈ 1 hour). During the first and last visit blood samples will be taken. Patients will be contacted twice during follow-up to evaluate (S)AE's. Treatment with the oral contraceptive pill is accompanied by a very low risk of developing thromboembolisms. Participation might benefit participants by reducing their migraine attack frequency or intensity.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Open-label randomized controlled trial
| Arm | Type | Receives |
|---|---|---|
| Ethinylestradiol/levonorgestrel | Experimental | Drug: Ethinylestradiol/levonorgestrelEthinylestradiol/levonorgestrel 30/150 µg oral tablets once daily without a stopweek for 3 months |
| Vitamin E | Active comparator | Drug: Vitamin EVitamin E 400 IU oral capsules once daily for 3 months |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Female
- Premenopausal with menstrual migraine OR migraine during the early menopausal transition phase (a difference of 7 days or more in length of consecutive cycles, which should occur at least twice in a period of 12 menstrual cycles)
- Demonstrated at least 80% compliance with eDiary during baseline period
- No or stable for at least two months on prophylactic medication
Key exclusion criteria (17 listed)
- Smoking
- Migraine with aura
- Chronic migraine with 15 or more headache days per month/with 8 or more migraine days per month
- Medication-overuse headache (ICHD-3 criteria)
- Women who are breastfeeding, pregnant, or planning to become pregnant
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Ethinylestradiol/levonorgestrelAlso: Microgynon 30, RVG 08204Ethinylestradiol/levonorgestrel 30/150 µg oral tablets once daily without a stopweek for 3 months | Drug | Ethinylestradiol/levonorgestrel |
| Vitamin EVitamin E 400 IU oral capsules once daily for 3 months | Drug | Vitamin E |
Primary outcome
Number of migraine days
Time frame: From baseline to the last 4 weeks of treatment (weeks 9-12)
Change in monthly migraine days
5 secondary outcomes
Number of headache days
Time frame: From baseline to the last 4 weeks of treatment (weeks 9-12)
Number of migraine attacks
Time frame: From baseline to the last 4 weeks of treatment (weeks 9-12)
Number of probable migraine attacks
Time frame: From baseline to the last 4 weeks of treatment (weeks 9-12)
Number of 50% responders
Time frame: From baseline to the last 4 weeks of treatment (weeks 9-12)
(Serious) adverse events
Time frame: Up to 3 months
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Dec 2023.
- Derived from this study: PubMed 38360739van der Arend BWH, van Casteren DS, Verhagen IE, MaassenVanDenBrink A, Terwindt GM. Continuous combined oral contraceptive use versus vitamin E in the treatment of menstrual migraine: rationale and protocol of a randomized controlled trial (WHAT!). Trials. 2024 Feb 15;25(1):123. doi: 10.1186/s13063-024-07955-8.
- Individual participant dataSharing planned: No
Related trials for Migraine
RecruitingObservational study
Study of the Glymphatic System in Migraine
Migraine
Active, not recruiting
Clinical and Neurophysiological Effects of tDCS to Visual and Motor Cortex in Migraine
Migraine
Active, not recruiting
App-Based Migraine Treatment: The Health enSuite Study
Migraine, Migraine With Aura
Not yet recruiting
A Prospective Study of Rimegepant for Short-term Preventive Treatment of Night-shift-related Migraine in Healthcare Professionals
Migraine Disorders
Recruiting
Marine Lipids Ease Painful TMD
Temporomandibular Disorder (TMD)
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Gisela M Terwindt, MD,PhD principal investigator
LUMC
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Ethinylestradiol/levonorgestrel and Vitamin E in people with Migraine and Migraine;Menstrual, run by Leiden University Medical Center at 1 site in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 8 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Britt WH van der Arend, MSc (+31715266065, B.W.H.van_der_Arend@lumc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Number of migraine days (time frame: From baseline to the last 4 weeks of treatment (weeks 9-12)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04007874, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Dec 2023.