A New Piece for the Migraine and Stroke Risk Puzzle

A recent study examining data from the Women’s Health Initiative suggests that a prior migraine diagnosis increases risk of ischemic stroke even after menopause.

Over the past decade, researchers have uncovered growing evidence that migraine, particularly migraine with aura, is associated with a heightened risk of stroke in women, especially at younger ages. To date, however, it was unclear if that higher risk continued past menopause, when women see relief not just from menstruation but often from their migraine symptoms as well. Overall stroke risk increases with age, which is another factor adding to the complexity of this area of research.

Now, researchers led by Tracy Madsen, University of Vermont, Burlington, US, have analyzed data from the Women’s Health Initiative (WHI) to examine potential links between migraine and stroke. Their analysis of more than 130,000 participants suggests a history of migraine confers a modestly higher risk of ischemic stroke, but not total or hemorrhagic stroke, long after women have gone through one of the great changes of life.

In an accompanying editorial, Tobias Kurth, Charité – Universitätsmedizin, Berlin, Germany, and Antoinette Maassen van den Brink, Erasmus MC, University Medical Center Rotterdam, the Netherlands, who were not involved with the study, wrote that the results “add important evidence” to the field’s knowledge of the migraine-stroke link.

“[T]he study by Madsen and colleagues advances our understanding of migraine-associated stroke risk in later life and reinforces the need to move beyond static exposure definitions. Incorporating information on migraine activity states, timing across the life course, and treatment history will be essential to understand the link between migraine and stroke better and to improve clinical translation,” they wrote.

Gretchen Tietjen, University of Toledo, US, who has studied the link between migraine and stroke in women but did not take part in the current study, agreed but added that she hopes the results will inspire additional studies.

“We’ve gotten a lot of interesting data on the association between stroke and migraine, but we need to be able to go deeper and look at different subpopulations and vascular characteristics so we can understand what’s really driving it,” she told Migraine Science Collaborative in an interview.

The study and editorial appeared in the July 14, 2026, issue of Neurology.

A consistent link
Madsen focuses her research on aspects of women’s health that contribute to stroke risk. She said the fact that women have a greater lifetime risk of stroke compared to men, just as there is a higher prevalence of migraine in women than in men, inspired her to examine the relationship between the two. She was especially interested to learn what she might find by studying older women.

“It was interesting to me that there have been a lot of papers in the past looking at migraine as a risk factor for stroke in younger women still in their reproductive ages, yet we hadn’t seen much about how it might affect older women, or those who have already gone through menopause,” she said.

To bridge that research gap, Madsen looked to the WHI data set, an ongoing longitudinal, prospective study of postmenopausal women. Women were enrolled into the WHI between 1993 and 1998. The median follow-up period for those in the current study was about 20 years.

The researchers accessed data from more than 160,000 women. They looked at baseline data to determine if participants had been diagnosed with migraine by a physician. They also scoured the decades of follow-up data to see whether those women had experienced stroke later in life. Women with a history of stroke or a transient ischemic attack (TIA), sometimes called a “mini-stroke,” at baseline were excluded from the analysis.

The study’s primary analysis population would ultimately include 130,277 women, who had a median age of 63 years. Of those women, 14,630 (11.2%) reported that they had been previously diagnosed with migraine. Of those, 612 had experienced a stroke. By comparison, 5,131 out of the 115,647 women without a history of migraine had a stroke.

After fully adjusting for variables like age, cardiovascular risk factors including blood pressure and atrial fibrillation, and “female-specific” factors such as age at menarche and menstrual irregularity, the investigators found a modest 12% increased risk of ischemic stroke in those with a history of migraine, compared to those with no migraine history; ischemic stroke is caused by a blood clot that blocks blood flow to the brain. There were no significant associations between migraine and total or hemorrhagic stroke.

When the researchers broke down ischemic stroke into subtypes, those with migraine had a 17% higher risk of cardioembolic stroke, which is when a blood clot that originates in the heart goes on to block blood vessels in the brain, and a 14% higher risk for stroke of undetermined subtype. Surprisingly, despite the fact that stroke risk is known to increase as people get older, the analyses did not show differences in stroke risk for the six different age groups considered in the study.

“Even when adjusting for all the other risk factors we know are important for stroke, like high blood pressure, diabetes, and abnormal heart rhythms, we still saw this association with ischemic migraine,” said Madsen. “And I think it shows why it’s important for clinicians to ask patients about their migraine histories even when these women are in their 60s, 70s, and 80s, to help them understand their patients’ risk.”

Moving beyond a binary
In their Neurology editorial, Kurth and Maassen van den Brink noted the “difficulty of interpreting migraine-stroke associations when migraine is treated as a single, time-fixed exposure.”

“Migraine evolves over the life course, with periods of activity, remission, and interictal phases,” they wrote. “As a result, a migraine diagnosis captured at a single time point may reflect markedly different biological and vascular states across individuals and ages.”

Tietjen concurred that knowing only whether participants had a diagnosis of migraine or not was a significant limitation of the study, and one that the authors acknowledge. This is an important limitation because different migraine characteristics may offer insights on why the migraine-stroke link, particularly the association with ischemic stroke, exists even at older ages.

“Knowing whether it’s active or non-active migraine, whether it’s migraine with aura, knowing the frequency and severity of the migraine, how it was treated – these factors might tell us more about why there’s this association,” she said. “It could also help us better evaluate which women with migraine may be most susceptible to later stroke.”

To that end, Tietjen said she hopes future studies will look at these factors, as well as brain imaging data, to see whether there is any shared endothelial or other vasculature-related dysfunction that may predispose certain women with migraine to stroke later in life.

Madsen said she and her colleagues are continuing to investigate the potential factors behind the migraine-stroke association. Another of her recent studies, which also used WHI data, found that systemic inflammatory biomarkers did not seem to explain the increased stroke risk in those with migraine.

“There are a lot of other things we can look at, from dysfunction of the blood vessels, changes in how the blood clots, or heart abnormalities that are related to both clotting problems and vascular problems,” she said. “It’s clear there’s a lot more work to do but, in the absence of this research, I do think incorporating a patient’s migraine history, even after menopause, into decision making when considering stroke risk factor modification is important. It can help physicians better protect women’s overall health and well-being.”

Kayt Sukel is a freelance writer based in Kansas.

Image credit: 123RF Stock Photo.

References
Migraine and stroke risk in postmenopausal women in the Women’s Health Initiative.
Madsen et al.
Neurology. 2026 Jul 14;107(1):e214825.

Does age matter in migraine-stroke risk?
Kurth T, van den Brink AM.
Neurology. 2026 Jul 14;107(1):e214890.