Migraine History Linked to Severe Hot Flashes in Postmenopausal Women

Tara Haelle

September 30, 2021

Women with a history of migraine are more likely to experience severe or very severe hot flashes than women without migraines, according to research presented Sept. 24 at the hybrid annual meeting of the North American Menopause Society. An estimated 1 in 5 women experience migraine, and women tend to have greater migraine symptoms and disability, the authors note in their background information. Since migraines are also linked to a higher risk of cardiovascular disease, the authors sought to learn whether migraines were associated with vasomotor symptoms, another cardiovascular risk factor.

"The question in my mind is, can we do better at predicting cardiovascular risk in women because the risk prediction models that we have really don't work all that well in women because they were designed for use in men," Stephanie S. Faubion, MD, MBA, Penny and Bill George director for Mayo Clinic's Center for Women's Health said in an interview. "My ultimate goal is to see if we can somehow use big data, artificial intelligence to figure out how to weight some of these female-specific or female-predominant factors to come up with a better model for cardiovascular risk prediction."

The researchers analyzed cross-sectional data from 3308 women who participated in the Data Registry on the Experiences of Aging, Menopause and Sexuality (DREAMS) study through Mayo Clinic sites in Rochester, Minnesota; Scottsdale, Arizona; and Jacksonville, Florida. The women ranged in age from 45 to 60 years old, with an average age of 53, and the vast majority of them were white (95%) and had at least some college (93%). Most were also in a long-term relationship (85%), and a majority were employed (69%) and postmenopausal (67%).

The data, collected between May 2015 and December 2019, included a self-reported history of migraine and questionnaires that included the Menopause Rating Scale of menopause-related symptoms.

The researchers adjusted their findings to account for body mass index (BMI), menopause status, smoking status, depression, anxiety, current use of hormone therapy, and presence of low back pain within the past year. "The diagnosis of low back pain, another pain disorder, was used to test the specificity of the association of migraine and vasomotor symptoms," the authors write.

Just over a quarter of the women (27%) reported a history of migraine, and these women's Menopause Rating Scale scores were an average 1.36 points greater than women without a history of migraines (P < .001). Women with self-reported migraine were also 40% more likely than women without migraines to report severe or very severe flashes versus reporting no hot flashes at all (odds ratio, 1.4; P = .02).

"The odds of reporting more severe hot flashes increased monotonically in women with a history of migraine," the authors report. "In addition, women with low back pain had higher Menopause Rating Scale scores, but were no more likely to have severe/very severe hot flashes than those without back pain, confirming the specificity of the link between vasomotor symptoms and migraine."

It's not clear if migraine or hot flashes are risk factors that add to a woman's existing cardiovascular risk profile or whether they are simply biomarkers of a shared pathway, Faubion said in an interview. She speculates that the common link between migraine and vasomotor symptoms could be neurovascular dysregulation.

Rachael B. Smith, DO, of the department of OB-GYN at the University of Arizona, Phoenix, was not involved in the research but found that hypothesis plausible as well.

"Our neurologic and vascular systems are coordinated physiologic processes working together for basic brain and body function," Smith said in an interview. Some of the symptoms of migraines and menopause are similar and both are often explained by the dysfunction of these systems. The association between history of migraines and severity of vasomotor symptoms is very likely to be explained by this dysregulation between the neurologic and vascular systems."

Smith also pointed out, however, that the largely homogeneous study population, all from the same national clinic system, makes it difficult to know how generalizable these findings are.

The primary clinical implications of these findings are that women's providers need to be sure they're asking their patients about migraine history and symptoms.

"The counseling we provide on menopausal symptoms should be better tailored to our patients' medical history, specifically inquiring about history of migraines and how this may impact their symptoms," Smith said.

The research was funded by the National Institutes of Health. Faubion and Smith had no disclosures.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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