Premenopausal bilateral oophorectomy linked to elevated migraine risk

Undergoing bilateral oophorectomy before menopause appears to contribute to an increased risk of migraine, according to a study.

Researchers looked at a cohort of 1,243 women who underwent premenopausal bilateral oophorectomy in Olmsted County, Minnesota, US, and 1,415 age-matched women as comparators. Those who received a migraine diagnosis before oophorectomy (or index) were excluded. Estrogen therapy after oophorectomy was evaluated as a time-dependent factor.

Compared with comparators, women who underwent premenopausal bilateral oophorectomy had a 59-percent higher risk of de novo migraine (hazard ratio [HR], 1.59, 95 percent confidence interval [CI], 1.24–2.05). The risk was especially pronounced in women who underwent the procedure before reaching the age of 45 years.

When looking at specific types of migraine, premenopausal bilateral oophorectomy was associated with an increased risk of migraine without aura but not of migraine with aura, which is consistent with menstrual migraines.

Further analysis indicated that the risk of de novo migraine did not significantly differ between women with oophorectomy off estrogen and comparators (HR, 0.80, 95 percent CI, 0.43–1.52). Conversely, women with oophorectomy who were using estrogen had a twofold greater risk of migraine relative to comparators (HR, 2.08, 95 percent CI, 1.47–2.92).

The increased migraine risk observed among women using estrogen may not be a side effect of the treatment itself, according to the researchers. It is possible that these women received a prescription for estrogen because their menopause symptoms, including migraines, were already more severe.

More studies are needed to investigate how the type, dose, and route of estrogen impact migraine outcomes after oophorectomy.