Use of contraceptives does not increase risk of vascular events in migraine

Key takeaways:

• The study included almost 14,000 adult U.S women diagnosed with migraine who used contraceptives.
• Risks of vascular events with lower estrogen-dose contraceptives should be evaluated.

SAN DIEGO — Contraceptive use did not significantly increase risk of vascular events overall for women who experience migraines, although those who experience migraine with aura had an increased risk, data show.

“We conducted this research with the goal to investigate the risk of vascular events associated with the use of oral contraceptives in migraine by comparing patients who use contraceptives versus (those who did) not,” Keiko Ihara, MD, joint headache researcher in the department of neurology at Keio University School of Medicine in Japan, said during her presentation at the American Headache Society Annual Scientific Meeting.

Ihara and colleagues conducted a retrospective study that culled data from a nationwide, deidentified electronic health record database of approximately 120 million individuals in the United States across multiple health care systems.

A total of 13,911 adult women with migraine diagnosis and at least three office visits within 3 years, who received at least one prescription of migraine-specific medication within 6 months of index date were identified who used combined hormonal contraceptives (CHCs) [n = 2,515; mean age 27.6±7.8 years; 55.1% white]) as well as those who did not (n = 11,396; mean age 32.9±8.1 years; 57.4% white). Also included as a subset for analysis were those who experienced migraine with (MwA; n = 3,834) and without aura (MwoA; n = 10,077).

The primary outcomes were patient experience with acute ischemic stroke, acute myocardial infarction, deep vein thrombosis or pulmonary embolism (DVT/PE) that required IV thrombolysis.

The researchers employed group-based comparisons and high-density propensity-score matching for data and demographic analyses, as well as for index year, follow-up intervals and a range of comorbidities.

According to results, the overall incidence of vascular events for the entire migraine cohort was 1.85% (acute ischemic stroke, n = 65; acute myocardial infarction, n = 24; DVT/PE, n = 176; IV thrombolytics, n = 19).

For those who used CHCs, 718 experienced MwA and 1,797 experienced MwoA; for those who did not use CHCs, 3,116 experienced MwA and 8,250 experienced MwoA.

Data additionally showed, among group comparisons, a significantly higher risk in the MwA group compared with MwoA for vascular events in those who were prescribed CHCs; however, CHC use did not significantly increase risk of vascular events in those with MwA.

“More studies are needed to assess the vascular risk that comes with more contraceptive use,” Ihara said.