Menopausal status modifies the association between migraine and cardiovascular disease risk: a nationwide cohort study
7 affiliations
- 1Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- 2Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
- 3Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
- 4Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- 5Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- 6Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- 7Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
Abstract
Background: To evaluate whether menopausal status modifies the association between migraine and cardiovascular disease (CVD) risk in women, using both relative and absolute risk measures.
Methods: We conducted a nationwide cohort study using Korean National Health Insurance Service data. Women aged ≥ 40 years who underwent the 2009 health screening and had no prior CVD (myocardial infarction or stroke) were included. Migraine was defined by using ICD-10 diagnostic codes. Menopausal status was determined from questionnaire-based reproductive history and prespecified as an effect modifier. Incident CVD and cardiovascular death were ascertained. Multivariable Cox models were used to estimate hazard ratios (HRs).
Results: Among 2,156,733 women, 923,517 were premenopausal and 1,233,216 postmenopausal. In premenopausal women, CVD incidence was higher in those with migraine than in those without migraine (2.22 vs. 1.38 per 1,000 person-years), with a higher risk after multivariable adjustment (HR 1.53, 95% CI 1.42–1.66). In postmenopausal women, CVD incidence was also higher among those with migraine (9.53 vs. 7.50 per 1,000 person-years), although the relative association was attenuated but remained significant (HR 1.20, 95% CI 1.17–1.23). Accordingly, the crude incidence rate difference associated with migraine was larger after menopause (2.03 vs. 0.84 per 1,000 person-years). The relative associations between migraine and cardiovascular outcomes were stronger in premenopausal women, whereas larger absolute risk differences were observed in postmenopausal women. This pattern was observed for CVD, myocardial infarction, and ischemic stroke, but not for cardiovascular death.
Conclusion: Migraine was associated with increased CVD risk in women. Relative associations were stronger before menopause, whereas absolute excess incidence was greater after menopause. These findings highlight the importance of considering migraine in cardiovascular risk assessment across the female life course, including after menopause.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s10194-026-02468-y.
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BibTeX
@article{kim2026menopausal,
title = {{Menopausal status modifies the association between migraine and cardiovascular disease risk: a nationwide cohort study}},
author = {Do Yeon Kim and Kyungdo Han and Jeen Hwa Lee and Sangwon Choi and Ye Seul Yang and Jeong-Yoon Lee and Jonguk Kim and Dae Young Cheon and Minwoo Lee},
journal = {The Journal of Headache and Pain},
year = {2026},
month = jul,
doi = {10.1186/s10194-026-02468-y},
url = {https://doi.org/10.1186/s10194-026-02468-y},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Menopausal status modifies the association between migraine and cardiovascular disease risk: a nationwide cohort study
AU - Do Yeon Kim
AU - Kyungdo Han
AU - Jeen Hwa Lee
AU - Sangwon Choi
AU - Ye Seul Yang
AU - Jeong-Yoon Lee
AU - Jonguk Kim
AU - Dae Young Cheon
AU - Minwoo Lee
PY - 2026
DA - 2026/07/29
JO - The Journal of Headache and Pain
DO - 10.1186/s10194-026-02468-y
UR - https://doi.org/10.1186/s10194-026-02468-y
AB - Background: To evaluate whether menopausal status modifies the association between migraine and cardiovascular disease (CVD) risk in women, using both relative and absolute risk measures. Methods: We conducted a nationwide cohort study using Korean National Health Insurance Service data. Women aged ≥ 40 years who underwent the 2009 health screening and had no prior CVD (myocardial infarction or stroke) were included. Migraine was defined by using ICD-10 diagnostic codes. Menopausal status was determined from questionnaire-based reproductive history and prespecified as an effect modifier. Incident CVD and cardiovascular death were ascertained. Multivariable Cox models were used to estimate hazard ratios (HRs). Results: Among 2,156,733 women, 923,517 were premenopausal and 1,233,216 postmenopausal. In premenopausal women, CVD incidence was higher in those with migraine than in those without migraine (2.22 vs. 1.38 per 1,000 person-years), with a higher risk after multivariable adjustment (HR 1.53, 95% CI 1.42–1.66). In postmenopausal women, CVD incidence was also higher among those with migraine (9.53 vs. 7.50 per 1,000 person-years), although the relative association was attenuated but remained significant (HR 1.20, 95% CI 1.17–1.23). Accordingly, the crude incidence rate difference associated with migraine was larger after menopause (2.03 vs. 0.84 per 1,000 person-years). The relative associations between migraine and cardiovascular outcomes were stronger in premenopausal women, whereas larger absolute risk differences were observed in postmenopausal women. This pattern was observed for CVD, myocardial infarction, and ischemic stroke, but not for cardiovascular death. Conclusion: Migraine was associated with increased CVD risk in women. Relative associations were stronger before menopause, whereas absolute excess incidence was greater after menopause. These findings highlight the importance of considering migraine in cardiovascular risk assessment across the female life course, including after menopause. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s10194-026-02468-y.
SN - 1129-2369
SN - 1129-2377
ER -