Abstract P697: Vasomotor Symptoms of Menopause Increase Stroke Risk in Migraineurs

Abstract

Introduction: The relationship between migraine and stroke, especially in migraine with aura, has been well-established. There is emerging evidence that vasomotor symptoms (VMS) such as hot flashes, flushing and night sweats associated with menopause increases the risk of vascular events, especially in the perimenopausal period. The aim of this study was to compare vascular risk factors in perimenopausal females with and without migraine with concomitant acute ischemic stroke (AIS). Methods: In this IRB approved study, we examined patient level data using the SlicerDicer function within Epic at a large, academic, comprehensive stroke center from 1/1/2015 to 1/1/2020. Inclusion criteria included female sex, age 42-65 years, and hospital diagnosis code of AIS. Hemorrhagic stroke, TIA, vasculopathy, and endocarditis associated strokes were excluded. Perimenopausal was defined as age ≥42 and ≤65 years. Hormonal and menopausal status was not available. We compared rates of co-morbidities by ICD10 codes of subjects with and without migraine using descriptive statistics and Chi squared analysis. Results: We identified 2296 (90%) women without migraine (Group 1) and 243 (10%) with migraine (Group 2) admitted for AIS. The five most common risk factors for AIS in group 1 were hypertension (56%), hyperlipidemia (37%), diabetes (30%), obesity (23%) and atrial fibrillation (11%). VMS was coded in 8% and tobacco use 7%. In group 2 we found hypertension (50%), hyperlipidemia (42%), migraine with aura (31%), obesity (23%), diabetes (20%). VMS was coded in 14%, atrial fibrillation in 12%, and tobacco use in 6%. Group 2 patients were more likely to have VMS (p = 0.008) and less likely to have diabetes (p=0.001). There were no other significant differences identified. Conclusions: Vasomotor symptoms in menopause are a significant risk factor for AIS in perimenopausal women with migraine. VMS should be assessed for clinically and included as a risk factor for stroke, especially in those with additional vascular risk factors. Future studies should include a diverse sample to assess the impact of VMS in a heterogeneous population.