Bronx, NY—New research suggesting that hormone therapy is safer than previously believed could offer another option for treating migraine headaches in women, notes a presentation at The North American Menopause Society (NAMS) Annual Meeting in Philadelphia.

The new study, led by researchers from the Albert Einstein College of medicine, was based on data from the Women’s Health Initiative (WHI) and demonstrates the safety of hormone use through the menopause transition.

“Hormone therapy use has been on the decline since the WHI clinical trials. Newer data has brought further clarity to its safe use, especially in younger women (aged <60 years) who are closer to the time of menopause (within 10 years of menopause),” explained coauthor Peter F. Schnatz, DO, immediate past president of NAMS. “Based on this newer data, hormones still have a major role in treating menopause symptoms and preventing bone loss. A number of these women will have migraines. Hence, knowing the risk/benefit profile of hormone therapy in these women is critically important.”

Prescribing hormones, including oral contraceptives, for migraine patients generally has been curtailed because of suspected association between exogenous estrogen use and an increased risk of stroke in women who experience the headaches, according to background information in the presentation report. 

To better understand the issue, researchers analyzed data for 67,903 participants of the WHI clinical trials to ferret out the relationship between migraines and cardiovascular disease events and their interaction with hormone-therapy use. 

They determined that women with migraines:
• Tended to drink and exercise less than those without migraines
• ˙Had higher vitamin D and calcium intake 
• Were more likely to have night sweats and hot flashes.

They did not uncover a significant risk of cardiovascular-disease events associated with a history of migraines, however. 

No increased risk of incident composite cardiovascular disease events—defined as myocardial infarction, stroke, angioplasty of coronary arteries, coronary bypass surgery, coronary heart disease, deep vein thrombosis, or pulmonary embolism—were detected in women with history of migraine in the WHI observational cohort, for a hazard ratio of 1.04 in fully adjusted models.

Of 17,357 participants in the WHI hormone trial, 1,482 reported migraine, and a nonsignificant decrease in composite CVD events was observed in the migraine group, with an HR of 0.71, the researchers note, explaining that a comparison of women with migraine who received hormone therapy, either estrogen or an estrogen/progesterone combination “did not show HT as an effect modifier for the association between migraine and composite CVD (HR 1.04 [0.42, 2.58] P = 0.929).”

“We did not detect significant risk of incident composite CVD events associated with history of migraine in this longitudinal cohort of older postmenopausal women,” study authors conclude. 

“Since migraines affect one in every four women and women with migraines are often advised to avoid hormone therapy, these findings may have significant public health implications,” added lead author Jelena Pavlovic, MD, PhD.
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