International Stroke Conference

International Stroke Conference

February 22, 2016
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Worsening migraines with hormone replacement linked to increased stroke risk in women

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Postmenopausal women who experience worsening migraines while using hormone therapy had an increased risk for ischemic stroke compared with women who were not currently using hormone replacement therapy, according to research presented at the International Stroke Conference.

“There has been a longstanding debate on whether hormone replacement therapy and migraines increase stroke risk. To date, the jury is still out. There [are] still some grey areas in our understanding of whether these are true independent stroke risk factors,” Haseeb A. Rahman, MD, from Zeenat Qureshi Stroke Institute in Minneapolis and a Neurology resident at Houston Methodist Hospital, Texas, said during a press conference.

Rahman said he and his colleagues observed in their own clinical setting a number of postmenopausal women with worsening migraines while on hormone therapy who were presenting with ischemic strokes.

“This was the first study, to our knowledge, that actually looked at migraines as they got worse, and whether that increases stroke risk in this subset of patients,” he said.

The study included 82,208 women aged 50 to 79 years participating in the Women’s Health Initiative. At the time of enrollment, all women were experiencing migraines. Forty-five percent of women were using hormone replacement therapy (unopposed estrogen and/or estrogen plus progesterone). The women were followed for 12 years and were asked to complete questionnaires indicating whether their migraines improved or worsened at 3-year follow-up.

Current hormone replacement therapy users had a significantly higher rate of increase in severity of migraines (20.6%) compared with women who never used hormone replacement therapy (17.3%) or reported previous use (18.7%; P < .0001 for comparison).

During the study period, 2,063 of the women had an ischemic stroke, according to results presented.

The OR for ischemic stroke was 1.1 (95% CI, 1.1-1.2) among current hormone therapy users who experienced no change or a decrease in migraine severity. The OR for ischemic stroke was 1.3 (95% CI, 1.1-1.5) among current hormone therapy users who experienced an increase in migraine severity compared with never users or past users.

“These findings suggest that women who have a history of migraines should talk to their doctor about the risks and benefits of hormone replacement, and if they choose to begin hormone replacement they should monitor migraine severity,” Rahman said. He also encouraged discussion between patients and health care providers about the development of first-time migraines during hormone therapy. “Physicians should not only address worsening migraines as they arise, but also keep in mind a potential of increased stroke risk that this may entail.” – by Tracey Romero

References:

Rahman H. et al. Abstract WMP 57. Presented at: International Stroke Conference; Feb. 16-19, 2016; Los Angeles.

Disclosures: Rahman reports no relevant financial disclosures.