Do Hormonal Contraceptives Confer Vascular Risks in Women With Migraine?

Exposure to estrogen-containing combined hormonal contraceptives (CHCs) is not associated with vascular risks in women with migraine with and without aura, according to study results presented at the 2025 American Academy of Neurology (AAN) annual meeting, held from April 5 to 9, 2025, in San Diego, California, and published in the journal Neurology.                  

Although CHC use has previously been linked to migraine with aura due to increased vascular risks, limited data are available on the vascular risks associated with modern-day CHCs in patients with migraine.

Researchers aimed to assess the link between vascular risks and estrogen-containing CHCs in migraine.

Using a nationwide electronic health record (EHR) database, women aged between 18 and 45 years with a migraine diagnosis and at least 3 office visits within 3 years and who received at least 1 migraine medication within 6 months of the first visit were included in the study.

The composite endpoint included acute ischemic stroke, acute myocardial infarction, deep vein thrombosis/pulmonary embolism, and intravenous thrombolytic administration. Incidence of the composite endpoint was compared between CHC users and nonusers and between those with migraine with and without aura.

A total of 5535 CHC users and 21520 nonusers with migraine were identified, of whom 114 (2.06%) users and 547 (2.54%) nonusers had at least 1 vascular event.

None of the patient subgroups showed significant differences in the composite endpoint between CHC use and nonuse. In addition, there was no difference in outcomes among CHC users with migraine with vs without aura. Among nonusers, migraine with vs without aura resulted in higher incidence of acute ischemic stroke and the composite endpoint (hazard ratio [HR], 2.45; 95% CI, 1.58-3.78; P <.001 and HR, 1.34; 95% CI, 1.08-1.67; P =.008, respectively).

“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,” the researchers concluded.