AAN 2025 | Estrogen exposure from modern hormonal contraceptives and vascular risk in women with migraine
Keiko Ihara, MD, Keio University School of Medicine, Tokyo, Japan, discusses a study investigating estrogen exposure from modern hormonal contraceptives and vascular risk in women with migraine. The study found that exposure to modern estrogen-containing combined hormonal contraceptives did not significantly increase the risks of vascular events in migraine. However, Dr Ihara emphasizes that this is an observational study, so prospective studies are needed to inform clinical practice. This interview took place at the 77th American Academy of Neurology (AAN) Annual Meeting in San Diego, CA.
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Transcript
It is well known that migraine with aura is a contraindication to estrogen-containing combined hormonal contraceptives and the main concern is the increased risk of vascular events, and it’s also known that the risks increase depending on estrogen levels, and additionally, the dosage of estrogen in modern contraceptives is substantially lower than when contraceptives were first introduced in the 1960s...
It is well known that migraine with aura is a contraindication to estrogen-containing combined hormonal contraceptives and the main concern is the increased risk of vascular events, and it’s also known that the risks increase depending on estrogen levels, and additionally, the dosage of estrogen in modern contraceptives is substantially lower than when contraceptives were first introduced in the 1960s. So we wanted to investigate the risk of vascular events associated with modern contraceptives in migraine. We used a nationwide de-identified electronic healthcare record database, and that enabled us to have access to more than 120 million American patients across multiple healthcare systems. And we included female patients aged 18 to 45 with a migraine diagnosis code, who had no prior vascular events, and who had also had regular healthcare appointments in recent years, and who also received at least one prescription for migraine-specific medications within six months following the index date. And about the outcomes we compared, we used this composite endpoint that consisted of acute ischemic stroke, acute myocardial infarction, deep vein thrombosis, and pulmonary embolism, and also we included intravenous thrombolytic administration not to miss any stroke diagnosis codes. And what we found is that exposure to modern estrogen-containing combined hormonal contraceptives did not significantly increase the risks of vascular events in migraine, migraine with aura, and migraine without aura subpopulations as well. And in addition, aura was associated with a significantly increased risk of vascular events in those who were not exposed to contraceptives only. We want to emphasize that more studies are needed for clinical implication because our research was based on observational findings, and to guide our clinical practice in the near future, it is necessary to test our hypotheses with prospective designs.
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