Abstract WMP57: Worsening Migraines in Current Hormone Replacement Therapy Users Predicts Higher Risk of Stroke

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Background: There has been a long-standing debate in the role of hormone replacement therapy (HRT) and migraines as risk factors for ischemic stroke. HRT are considered a risk factor for migraines. The risk of ischemic stroke may increase as the severity of migraines increases in patients that are currently using HRT. Methods: We analyzed the data for 82,208 women aged 50 - 79 years who were enrolled in the observational arm of the Women’s Health Initiative Study. We determined the risk of ischemic stroke in participants with migraines who had current Hormone replacement therapy (HRT) (unopposed estrogen and/or estrogen plus progesterone), past HRT, and no HRT. We further dichotomized participants with migraines into participants who experienced an increase in migraine severity of one grade or more from baseline on the third-year follow up visit and participants who experienced no change or a decrease in migraine severity from baseline on the third-year follow up visit. The relative risk of developing ischemic stroke was compared between participants who were currently on HRT and participants who were either previously on HRT or never had HRT. Results: Out of the 82,208 women, 37680 (45.8%) were currently using HRT and 44528 (54.2%) were either past users or had never used HRT therapy. Compared with never or past users of HRT, rate of increase in severity of migraines was significantly higher among those who were currently on HRT therapy (17.3% versus 18.7% versus 20.6%, respectively, p<0.0001). Odds ratio (OR) of ischemic stroke for patients who never used HRT or used HRT only in the past compared to those who were current users and experienced no change or a decrease in migraine severity was 0.91 [confidence interval (CI) 0.88 - 0.94] versus 1.1 [CI 1.1 - 1.2], (p<.0001). OR of ischemic stroke for patients who never used HRT or used HRT only in the past compared to those who were current users and experienced an increase in severity of migraines was 0.81 [CI 0.74 - 0.88] versus 1.3 [CI 1.1 - 1.5] (p<.0001). Conclusions: Patients that are current users of HRT that have an increase in severity of one grade or more of migraines are shown to have an increased risk of ischemic strokes. Future studies are required to further investigate these correlations.