Migraine Prior to Menopause Could Signal Increased Hypertension Risk

Gianluca Severi, PhD

A study of more than 55,000 European women suggests women experiencing migraines prior to entering menopause could be at a greater risk of developing high blood pressure.

The study, which assessed more than 826,000 person-years of data, found those with a history of migraine prior to menopause had a 29% greater risk of developing hypertension than those without and also indicate this risk could be even greater among women using menopausal hormone therapy.

“Since previous research shows migraine increases the likelihood of cardiovascular events, identification of additional risk factors such as the higher likelihood of high blood pressure among people with migraine could aid in individualized treatment or prevention,” said study investigator Gianluca Severi, PhD, of the French National Institute of Health and Medical Research in Paris, in a statement. “Doctors may want to consider women with a history of migraine at a higher risk of high blood pressure.”

Despite previous studies providing evidence establishing migraine as a potential risk factor for hypertension, Severi and a team of colleagues noted no studies had assessed associations between migraine and hypertension after menopause, which is when migraine prevalence among women typically decreases. With this in mind, the European-based team designed the current study with the goal of describing whether history of migraine was associated with risk of hypertension among menopausal women.

To do so, investigators obtained data for a study population from the Etude Épidémiologiquede femmes de la Mutuelle Générale de l´Education (E3N). Launched in 1990, the prospective cohort of French women contained data related to 98,995 women aged 40-65 years at baseline who were followed for up to 20 years.

As part of the follow-up procedure in E3N, patients completed questionnaires related to lifestyle information and disease occurrence every 2-3 years after enrolling in the study. Based on responses, investigators excluded more than 40,000 women from their analysis based on presence of insufficient data to determine menopausal status, history of cardiovascular disease prior to menopause, and history hypertension prior to menopause. In total, 56,202 women were identified for inclusion in the analysis.

For the purpose of analysis, patients were asked to define migraine presence as ever or never during questionnaire cycles. With this and other information obtained related to baseline clinical and demographic data, investigators hoped to use Cox proportional hazards models to assess associations between migraine and hypertension. Investigators also noted plans for a secondary analysis with baseline in 2011 considered aura status, grouping participants reporting migraine as migraine with aura, migraine without aura, or unknown migraine type.

During 826,419 person-years of follow-up, investigators identified 12,501 cases of incident hypertension and 11,030 women reporting a history of migraine. Among the 12,501 cases of incident hypertension, 3100 cases occurred in women with migraine (19.2 per 1000 person-years) and 9401 occurred in women without migraine (14.3 per 1000 person-years). In adjusted analysis, migraine was associated with a 29% increased risk of incident hypertension (HR, 1.29; 95% CI, 1.24-1.35).

Investigators found this apparent increase in the risk of incident hypertension was consistent in sensitivity analyses. Further analysis indicated associations between migraine and hypertension were similar whether or not women reported aura ([with aura] HR, 1.54; 95% CI, 1.04-2.30; [no aura] HR, 1.32; 95% CI, 0.87-2.02; P for heterogeneity=.60). Additionally, observed associations were stronger among women who reported use of menopausal hormone therapy than those who reported never using menopausal hormone therapy (HR, 1.19; 95% CI, 1.11-1.28).

This study, “Association of Migraine With Incident Hypertension After Menopause: A Longitudinal Cohort Study,” was published in Neurology.