Journal article
Migraine and Stroke Risk in Postmenopausal Women in the Women's Health Initiative
Neurology, v 107(1), e214825
14 Jul 2026
PMID: 42247650
Featured in Collection : Drexel's Newest Publications
Abstract
Migraine is a known risk factor for stroke in women of reproductive age, although its relationship with stroke among postmenopausal women remains unclear. We assessed the association between migraine history and incident stroke in a sample of postmenopausal women.
We included women enrolled in the Women's Health Initiative, a large US longitudinal cohort study of postmenopausal women, and excluded those with previous stroke or those with missing data on key variables. The primary exposure was self-reported, physician-diagnosed migraine at baseline, and the primary outcome was incident stroke (total, ischemic, or hemorrhagic). Multivariable Cox proportional hazards models were used to test the cause-specific hazard ratios (HRs) between migraine history and total, ischemic (overall and by subtype), and hemorrhagic stroke, sequentially adjusted for age, traditional cardiovascular risk factors, and female-specific risk factors (age at menopause, age at menarche, menstrual irregularity, presence of vasomotor symptoms, parity, breastfeeding, and use of menopausal hormone therapy). We then quantified the association between a history of migraine and total stroke by age at baseline (in 5-year age groups) using multivariable models. Data on the presence of aura and migraine frequency were not available.
Participants (N = 130,277) had a median age of 63 years (interquartile range [IQR] 57-69). A total of 5,743 incident stroke events occurred over a median follow-up period of 19.9 years (IQR 9.1-25). In multivariable models, there was no significant association between migraine history and total stroke (HR 1.07, 95% CI 0.99-1.17), but there was a significant association between migraine history and ischemic stroke (HR 1.12, 95% CI 1.02-1.23). In planned secondary analysis of ischemic subtypes, the associations were most pronounced in the cardioembolic (HR 1.17, 95% CI 0.98-1.39) and undetermined (HR 1.14, 95% CI 0.98-1.33) categories. Migraine was not associated with hemorrhagic stroke (HR 0.85, 95% CI 0.67-1.09). Risk did not differ significantly by age group.
Over 20 years of follow-up, postmenopausal women with a history of migraine had a higher risk of ischemic stroke, but not total or hemorrhagic stroke. Along with other factors, a history of migraine should be considered a risk marker when assessing ischemic stroke risk after menopause.
Metrics
1 Record Views
Details
- Title
- Migraine and Stroke Risk in Postmenopausal Women in the Women's Health Initiative
- Creators
- Tracy E Madsen - University of VermontChristina A Raker - Brown UniversityJelena M Pavlovic - Albert Einstein College of MedicineLaura B Harrington - Kaiser Permanente Washington Health Research InstitutePeter F Schnatz - Rowan UniversityMarcia L Stefanick - Stanford UniversityMatthew Allison - University of California San DiegoAladdin H Shadyab - Human Longevity (United States)Simin Liu - University of California, IrvineDonald B Penzien - Wake Forest UniversityBernhard Haring - Saarland UniversityRobert A Wild - University of Oklahoma Health Sciences CenterLongjian Liu - Drexel UniversityNazmus Saquib - Sulaiman Al Rajhi CollegesJean Wactawki-Wende - University at Buffalo, State University of New YorkFarha Ikramuddin - Mayo Clinic in ArizonaMichael J LaMonte - University of MinnesotaJoAnn E Manson - Brigham and Women's HospitalBrian Silver - University of Massachusetts Chan Medical School
- Publication Details
- Neurology, v 107(1), e214825
- Publisher
- American Academy of Neurology
- Number of pages
- 12
- Grant note
- American Heart Association: 23MRFSCD1077187 National Heart, Lung, and Blood Institute, NIH, US Department of Health and Human Services: 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00005
This analysis was funded by the American Heart Association (23MRFSCD1077187). The WHI program is funded by the National Heart, Lung, and Blood Institute, NIH, US Department of Health and Human Services through contracts 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005. The investigators had sole responsibility for the data analysis and interpretation reported in this manuscript. The funder did not actively participate in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the NIH; or the US Department of Health and Human Services.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:001786745200001
- Other Identifier
- 991022191398304721