Women whose migraine attacks worsen on hormone replacement therapy may have an increased risk of stroke, according to a paper presented at the American Stroke Association meeting in February.

Women who were using hormone replacement therapy at the time of the study were 30% more likely to have a stroke caused by a blood clot (an ischemic stroke) than those who never took hormone replacement therapy or who had taken it in the past. They also found that women currently on hormone replacement therapy had worse migraine attacks than those not on it.

“Many post-menopausal women use hormone replacement therapy, and a large number also experience migraines, although we’re not sure if these put them at greater risk of stroke. The question we wanted to address was whether there is a greater risk of stroke if migraines are becoming more severe while taking hormone replacement,” said Haseeb A. Rahman, M.D., lead author from the Zeenat Qureshi Stroke Institute in Minneapolis, MN, and a neurology resident at Houston Methodist Hospital in Texas. “While earlier studies have looked at both as risk factors for stroke, they have sometimes come to different conclusions, and there are still ‘gray areas’ in our understanding.”

Researchers analyzed data from 82,208 women ages 50-79. All of the women had migraine when they enrolled in the study and nearly half (45%) were using hormone replacement therapy. Three years later, participants completed a questionnaire to determine whether their migraine severity had increased, decreased, or stayed the same. In the 12 years of the data collection, 2,063 women had an ischemic stroke. After adjusting for stroke risk factors, researchers found a significant connection between hormone replacement therapy, migraine severity, and stroke risk.

If you have migraine and are considering hormone replacement therapy, please talk to your doctor about the pros and cons and how to manage other stroke risk factors. If you start hormone replacement therapy, keep a migraine diary to track whether your migraine frequency, severity, or duration changes. If your migraine attacks worsen in any way, contact your doctor immediately. If you’ve never had a migraine attack before, but starting having them on hormone replacement therapy, you should also contact your doctor immediately.

REFERENCE

Rahman, H. A.; Malik, A.; Saeed, O.; Thomas, A., & Qureshi, A. (2016, February 17). Worsening Migraines With Hormone Replacement Linked to Stroke Risk. Paper Presented at the International Stroke Conference, Los Angeles, CA.