Increased Risk of Hypertension Seen in Postmenopausal Women With History of Migraine

Women who suffer from migraine prior to menopause onset may be more likely to develop high blood pressure after menopause, according to a study published in Neurology, the medical journal of the American Academy of Neurology.

Although some previous studies have examined migraine prevalence after menopause and found decreased prevalence at this time, more research is needed in this area and no studies have examined if migraine is associated with hypertension after menopause.

Research has also indicated migraine is a potential risk factor for hypertension, while migraine with aura “has been identified as a risk factor for cardiovascular disease (CVD),” the authors wrote. They added that, “migraine prevalence is 3 to 4 times higher in women than in men during the fourth decade of life, which is possibly due to differences in sex hormones."

To determine whether history of migraine is associated with hypertension after menopause, researchers conducted a longitudinal cohort study of more than 56,000 French menopausal women. The Etude Épidémiologiquede femmes de la Mutuelle Générale de l ́Education (E3N) began in 1990 and recruited women aged 40 to 65 years at baseline. Every 2 to 3 years, participants mailed completed questionnaires on lifestyle information and disease occurrence to researchers.

After excluding women with insufficient data to determine menopausal status and those with CVD or hypertension incidence prior to 1993 or menopause onset, deidentified data from 56,202 menopausal women were included in the study.

Sensitivity analyses controlled for commonly prescribed migraine drugs were also carried out. Researchers defined age at menopause as either age at last menstrual period, age at bilateral oophorectomy, self-reported age at menopause, age at start of menopausal hormone therapy (MHT) or age at the start of menopausal symptoms.

By the end of the study in 2005, a total of 11,030 women reported having ever had migraine, while 12,501 developed high blood pressure throughout the study window. The average age of women without migraine diagnosed with hypertension was 65, while mean age was younger for migraineurs diagnosed with hypertension (63).

Analyses revealed:

• During 826,419 person years, 12,501 cases of incident hypertension were identified, including 3100 among women with migraine, and 9401 among women without migraine.
• Migraine was associated with an increased risk of hypertension in menopausal women (hazard ratio [HR] 1.29; 95% CI, 1.24-1.35]); this finding was consistent in post-hoc sensitivity analyses when controlling for common migraine medications.
• Associations between migraine and hypertension were similar whether or not women reported aura: HR with aura 1.54 (95% CI, 1.04-2.30); HR without aura 1.32 (95% CI, 0.87-2.02) P = .60.
• Associations of migraine and hypertension were slightly stronger among ever users of MHT (HR 1.34; 95% CI, 1.27-1.41), than among never users (HR 1.19; 95% CI, 1.11-1.28)

Overall, adjusted analyses showed participants who had migraine prior to menopause were 29% more likely to develop high blood pressure after menopause.

Several explanations exist as to why migraine may be associated with high blood pressure. “People with migraine have been shown to have early signs of arterial stiffness. Stiffer, smaller vessels are not as capable of accommodating blood flow, resulting in pressure increases. It is also possible that associations could be due to genetics,” said study author Gianluca Severi, PhD.

“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,” she said.

Limitations to the study include self-reported migraine incidence, which may be subject to classification error. Self-reported incidences of hypertension also mark a limitation. As the cohort consisted of a high percentage of high school teachers, results may not be generalizable to the wider French population.

“Practitioners should be made aware that women with a history of migraine should be considered to be at a higher risk of hypertension,” authors concluded.

Reference

MacDonald CJ, El Fatouhi D, Madika A, et al. Association of migraine with incident hypertension after menopause: a longitudinal cohort study. Neurology. Published online April 21, 2021. doi:10.1212/WNL.0000000000011986