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The effect of menopausal hormone therapy on headache and migraine severity: results from the Women's Health Initiative Hormone Therapy Clinical Trials
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The effect of menopausal hormone therapy on headache and migraine severity: results from the Women's Health Initiative Hormone Therapy Clinical Trials

H M Crowe, Kathryn Rexrode, Janet W. Rich-Edwards, T Madsen, Aladdin H. Shadyab, Longjian Liu, Leslie V. Farland, Peter F Schnatz and Marcia Stefanick
Headache, v 65(S1), pp 100-100
01 Jun 2025
DOI: https://doi.org/10.1111/head.14957
PMID: 40536326
url
https://doi.org/10.1111/head.14957View
Published, Version of Record (VoR) Open Maybe Open Access (Publisher Bronze)

Abstract

Clinical Neurology Life Sciences & Biomedicine Neurosciences & Neurology Science & Technology
Background: Migraine is three times more common among women than men and is a major source of pain and disability among women throughout the life course. Previous cross-sectional research found a positive association between using menopausal hormone therapy (MHT) use and migraine prevalence, but the longitudinal impact of MHT on postmenopausal migraine severity is unknown. Methods: We examined changes in self-reported headache severity between baseline and year 1 of the WHI MHT trial using logbinomial regression to estimate the effect of MHT on headache severity, stratifying by history of migraine at baseline. Results: The prevalence of a baseline lifetime history of migraine in the population was 10%. Thirty-five percent of individuals with a history of migraine and 8% of individuals without a history of migraine reported moderate to severe headaches at year 1. Migraine history was a significant predictor of worsening headache after controlling for MHT use (RR = 1.45, 95%CI 1.34–1.56). Randomized MHT was associated with a small increase in risk of moderate to severe (vs. none or mild) headache at year 1, regardless of migraine history (Eonly RR = 1.11, 95% CI: 0.94–1.30, E+P RR = 1.20 95% CI: 1.01–1.42). Randomization to E+P was associated with a slight increase in risk of worsening headache (RR = 1.15, 95% CI: 1.06–1.24), while randomization to E-only did not increase headache severity (RR = 1.04, 95% CI: 0.95–1.14). Estimates were similar among those with and without a history of migraine (pinteraction >05.) Conclusion: Allocation to randomized MHT conferred a slightly higher risk of more severe headache after 1 year. While randomization to E+P was associated with a small risk of worsening headache, this increase in risk was not present among those randomized to Eonly. Risk of worsening headache did not differ among subgroups with or without a history of migraine.

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