Hypertension Risk Elevated in Menopausal Women With Migraine

Disease Spotlight | <b>Disease Spotlight: Migraine</b>

Migraine with aura was associated with the risk of incident hypertension and no significant difference was observed between individuals with or without aura.

Research from a longitudinal cohort study of menopausal women demonstrated an increased risk of hypertension in those with a history of migraine, as well as no significant differences between migraine with and without aura.

A total of 56,202 menopausal women participating in the French E3N cohort had data collected on the relations between migraine and hypertension, controlling for potential confounding and using Cox proportional hazards models. Researchers identified 12,501 cases of incident hypertension, including 3100 among women with migraine, and 9401 among women without migraine, across 826,419 person years.

The study excluded women with hypertension or cardiovascular disease at the age of their menopause. Migraine was classified as ever or never at each questionnaire cycle completed every 2 to 3 years from 1990 to 2014.

Lead author Conor J. MacDonald, PhD, French Institute of Health and Medical Research, and colleagues concluded that not only was migraine associated with an increased risk of hypertension in menopausal women (hazard risk [HR] migraine, 1.29 [95% CI, 1.24-1.35]), but that these associations remained consistent after controlling for common migraine medications.

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The incident rate of hypertension was 14.3 per every 1000 person-years in women without migraine compared to 19.2 per 1000 person-years among women with migraine. MacDonald et al wrote, "practitioners should be made aware that women with a history of migraine should be considered at a higher risk of hypertension.”

As previously mentioned, these associations between migraine and hypertension were similar whether or not women reported aura (HR migraine aura, 1.54 [95% CI, 1.04-2.30]; HR migraine no aura, 1.32 [95% CI, 0.87-2.02]; P-heterogeneity = .60). Overall, the incidence rate of hypertension among women with no migraine was 10.9 per 1000 person-years compared to 16.8 per 1000 person-years among women with migraine with aura and 14.4 per 1000 person-years among women with migraine without aura.

The associations of increased hypertension risk with history of migraine were not modified by age at menopause (P-interaction = 0.78), nor did the type of menopause (P-interaction = 0.19).Women who used menopausal hormone therapy (MHT; HR migraine, 1.34 [95% CI, 1.27-1.41]) were found to have slightly stronger associations to hypertension than among never users (HR migraine, 1.19 [95% CI, 1.11-1.28]).

"There are multiple routes in which migraine may be linked to hypertension. People with migraine have been shown to have early signs of arterial stiffness and increased blood pressure, and as treatment, patients with migraine can be prescribed vasoconstrictors, which reduce the diameter of blood vessels. Stiffer, smaller vessels are unable to accommodate the systolic blood flow by dilating, resulting in pressure increases,” MacDonald et al wrote.

The authors noted 2 previous prospective studies that have identified the association between migraine with an increased risk of hypertension. The first, a study published by Pamela M. Rist, ScD, et al., showed that compared to those with no history of migraine, women who experienced migraine with aura had a 9% increase in their risk of developing hypertension; women who experienced migraine with aura had a 21% increase in their risk of developing hypertension; and women with a past history of migraine had a 15% increase in their risk of developing hypertension.2

MacDonald and colleagues also noted a study published in 2014 and led by Anitta H. Entonen, which showed that self-reported migraine predicted hypertension in selected initially non-hypertensive working-age participants. Those findings suggested that a focus on hypertension screening is needed for the working-age population with migraine.3

REFERENCE
1. MacDonald CJ, Fatouhi DE, Madika AL, et al. Association of migraine with incident hypertension after menopause: a longitudinal cohort study. Neurology. Published online April 12, 2021. doi: 10.1212/WNL.0000000000011986
2. Rist PM, Winter AC, Buring JE, Sesso HD, Kurth T. Migraine and the risk of incident hypertension among women. Cephalagia. 2018;38(12):1817-1824. doi: 10.1177/0333102418756865
3. Entonen AH, Suominen SB, Korkeila K, et al. Migraine predicts hypertension—a cohort study of the Finnish working-age population. Eur J Public Health. 2014;24(2):244-248. doi: 10.1093/eurpub/ckt141