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Abstract Details

Estrogen Exposure from Modern Hormonal Contraceptives and Vascular Risk in Women with Migraine: A Nationwide Electronic Health Record Database Study
Headache
S35 - Hot Topics in Headache (1:12 PM-1:24 PM)
002
Several guidelines list migraine with aura (MwA) as a contraindication to CHC use due to increased vascular risks. However, modern CHCs contain substantially lower dosages of estrogen than when first introduced in 1960. The vascular risk associated with modern CHCs in patients with migraine is understudied.

To assess vascular risk associated with estrogen-containing combined hormonal contraceptives (CHCs) in migraine by leveraging a nationwide electronic health record (EHR) database
Using a US-nationwide de-identified EHR database, we included female patients aged 18-45 with a migraine diagnosis who had ≥3 office visits within 3 years and were prescribed ≥1 migraine-specific medication within 6 months following the first outpatient visit. Data after 2010 was used, excluding patients with prior cardiovascular events. We compared the incidence of a composite endpoint, consisting of acute ischemic stroke, acute myocardial infarction, deep vein thrombosis/pulmonary embolism, and intravenous thrombolytic administration, between CHC users and non-users, and between MwA and MwoA subgroups in the overall migraine cohort and in each subgroup by high-dimensional propensity score matching.
We identified 5535 CHC users and 21520 non-users with migraine. 114 (2.06%) users and 547 (2.54%) non-users had ≥1 vascular event. For the overall migraine group, and separately in the MwA and MwoA subgroups, there was no significant difference in the composite endpoint between users and non-users. Among users, MwA and MwoA did not significantly differ in the outcomes. For non-users, MwA was associated with a higher incidence of acute ischemic stroke (HR 2.45; 95%CI, 1.58–3.78; p<0.001) and composite endpoint (HR 1.34; 95%CI, 1.08–1.67); p=0.008), compared to MwoA.

Our real-world, large data analysis showed that in young female migraine patients, estrogen exposure from CHCs was not associated with vascular risks, suggesting the need for re-evaluation of current guidelines. We also confirmed that aura increased vascular risk in patients with migraine not using CHCs.
Authors/Disclosures
Keiko Ihara, MD (Japanese Red Cross Ashikaga Hospital)
PRESENTER 		Dr. Ihara has nothing to disclose.
Conner W. Pike, MD Dr. Pike has received personal compensation for serving as an employee of Atropos Health.
gavin hui, MD Dr. hui has nothing to disclose.
Saurabh Gombar, MD, PhD Dr. Gombar has nothing to disclose.
Alison Callahan, PhD Dr. Callahan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atropos Health. Dr. Callahan has stock in Atropos Health. Dr. Callahan has received intellectual property interests from a discovery or technology relating to health care.
Mike Jackson Mr. Jackson has received personal compensation for serving as an employee of Atropos Health. Mr. Jackson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atropos Health.
Gretchen E. Tietjen, MD (University of Toledo) Dr. Tietjen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Tietjen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CME Outfitters. An immediate family member of Dr. Tietjen has stock in Johnson & Johnson.
Chia-Chun Chiang, MD (Mayo Clinic) Dr. Chiang has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Satsuma. Dr. Chiang has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aruene Corporation . The institution of Dr. Chiang has received research support from American Heart Association.