Abstract Details

Title Migraine with Aura and New Combined Hormonal Contraceptives: A Retrospective Analysis of Thrombotic Events

Topic Headache

Presentation(s) S40 - (-)

Poster/Presentation
Number 002

Background The use of CHCs in women with aura is controversial, owing to worries about the synergistic thrombotic risks of MwA and estrogen. Newer CHCs have been associated with an increased risk of thrombotic events. A recent FDA analysis suggested an increased risk of DVT in users of newer CHCs. There are limited data on the use of the newer CHCs in patients with migraine with aura.

Objective

Design/Methods We used the computerized Research Patient Data Registry (RPDR) of Partners Healthcare to identify a cohort of unique patients with MwA and MWoA who had been prescribed: levonorgestrel/ethinyl estradiol, norethindrone/ethinyl estradiol, norgestimate/ethinyl estradiol, (older agents) or drospirenone, norgestromin/ethinyl estradiol transdermal patch, etonogestrel/ethinyl estradiol vaginal ring, (newer agents). Within these groups we searched for diagnoses of selected thrombotic events.

Results Out of a total population of almost 2 million women seen over the period 2001-2012, we identified roughly 145,304 who had used the selected CHCs. When evaluated by migraine type, a larger proportion of patients with MwA had experienced selected thrombotic complications compared with patients with MWoA. For example, 7.6% of women with MwA who used drosperinone-ethinyl estradiol were diagnosed with DVT compared with 6.3% of women with MWoA. Higher rates of thrombotic complications were observed with all CHCs in women with MwA compared with those with MWoA and with both newer and older contraceptives. Rates of thrombotic complications were higher in the migraine-CHC group than a comparable group of women without migraine using CHCs.

Conclusions These preliminary data support the view that migraine, particularly migraine with aura is associated with an elevated risk of thrombotic complications in women who use CHCs. The risk appears particularly high with newer agents.

Authors/Disclosures
Shivang Joshi, MD (Community Neuroscience Services) PRESENTER	Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Joshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lilly. Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Currax. Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Relivion. Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nerivio. Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Axiome. Dr. Joshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biohaven. Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. Dr. Joshi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. Dr. Joshi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. Joshi has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Lilly. Dr. Joshi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Joshi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Impel. Dr. Joshi has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biohaven. The institution of Dr. Joshi has received research support from Lilly . The institution of Dr. Joshi has received research support from Biohaven. The institution of Dr. Joshi has received research support from Amgen.
Rebecca C. Burch, MD (University of Vermont)	An immediate family member of Dr. Burch has received personal compensation for serving as an employee of Wellsky. Dr. Burch has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. An immediate family member of Dr. Burch has stock in Wellsky. Dr. Burch has received publishing royalties from a publication relating to health care.
Elizabeth Loder, MD, FACP	Dr. Loder has received personal compensation in the range of $5,000-$9,999 for serving as an officer or member of the Board of Directors for Headache Cooperative of New England. The institution of Dr. Loder has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The BMJ.
Albert Saiz (Hospital Clinico De Barcelona)	Albert Saiz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Albert Saiz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Albert Saiz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Albert Saiz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janseen. Albert Saiz has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Albert Saiz has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for novartis. Albert Saiz has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen.
Darcy Krueger, MD (Cincinnati Children'S Hospital Medical Center)	Dr. Krueger has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NobelPharma USA. Dr. Krueger has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for RegenxBio. Dr. Krueger has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis Pharmaceuticals. Dr. Krueger has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Greenwich Biosciences. The institution of Dr. Krueger has received research support from Greenwich Bioscience. The institution of Dr. Krueger has received research support from Marinus Pharmaceuticals. The institution of Dr. Krueger has received research support from National Institutes of Health. The institution of Dr. Krueger has received research support from Food and Drug Administration. The institution of Dr. Krueger has received research support from TSC Alliance.

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