Migraine History Linked to Elevated Ischemic Stroke Risk in Postmenopausal Women: WHI Analysis

Postmenopausal women with a history of physician-diagnosed migraine face a modestly higher risk of incident ischemic stroke, independent of traditional cardiovascular and sex-specific risk factors, according to a major new analysis of the Women’s Health Initiative (WHI) cohort published in Neurology. The study, which included substantial contributions from METRICS member Dr. Simin Liu, bridges a significant knowledge gap, demonstrating that the well-established migraine-stroke link observed in younger, premenopausal women persists into later life—the demographic with the highest absolute burden of stroke death and disability.

While the association between migraine (especially migraine with aura) and stroke is documented in reproductive-age women, data regarding this relationship in the postmenopausal period have been scarce. The WHI analysis involved 130,277 women (median age 63) free of stroke at baseline and followed for a median of 19.9 years. During this extensive follow-up, 5,743 incident strokes occurred.

The study design utilized multivariable Cox proportional hazards models sequentially adjusted for age, traditional cardiovascular risk factors (hypertension, diabetes, smoking, AF, CVD), and crucially, sex-specific factors (age at menopause/menarche, vasomotor symptoms, and menopausal hormone therapy (MHT)). Although self-reported physician-diagnosed migraine was not associated with total stroke or hemorrhagic stroke in fully adjusted models, a significant 12% increased hazard for ischemic stroke was identified.

Key Diagnostic Performance & Statistical Metrics

Postmenopausal women with a reported migraine history exhibited the following adjusted hazard ratios compared to those without migraine:

*Fully adjusted model includes: age, race/ethnicity, education, BMI, smoking, alcohol, diabetes, hypercholesterolemia, hypertension, CVD, atrial fibrillation, cancer, age at menopause/menarche, menstrual regularity, vasomotor symptoms, parity, breastfeeding, and MHT use.

Exploratory analyses by ischemic subtype (TOAST criteria) suggested the association was strongest within the cardioembolic (HR 1.17, 0.98–1.39) and undetermined (HR 1.14, 0.98–1.33) categories, though these estimates had wider confidence intervals.

Clinical Implications for Preventive Cardiology

«Over 20 years of follow-up, postmenopausal women with a history of migraine had a higher risk of ischemic stroke,» the study authors conclude. «Along with other factors, a history of migraine should be considered a risk marker when assessing ischemic stroke risk after menopause.«

This finding has immediate practical implications for preventive practice. Busy clinicians should integrate a patient’s lifetime migraine history into routine postmenopausal cardiovascular risk assessments. The study results emphasize that migraine is not merely a condition of the reproductive years; its vascular footprint may persist long after the menopause transition.

While the absolute risk increase identified is relatively modest, the sheer scale and extended follow-up of the WHI study (accounting for factors like atrial fibrillation and MHT use) strengthen the conclusion that this association warrants clinical attention. Future research is needed to determine if these risks vary significantly by migraine subtype (with vs. without aura) and how ongoing medication use might further modulate this risk in later life.

Citation: Migraine and Stroke Risk in Postmenopausal Women in the Women’s Health Initiative. June 2026. Neurology 107(1):e214825 DOI: 10.1212/WNL.0000000000214825