Worsening Migraine With Hormone Replacement Therapy May Increase the Likelihood of Stroke
Women who experience more severe migraines while taking hormone replacement therapy may have an increased risk of stroke, compared with women whose migraines worsen but who are not taking hormone replacement therapy, according to an analysis of data from the Women’s Health Initiative Study.
This finding suggests that patients who begin hormone replacement therapy should monitor changes in migraine severity and address other modifiable risk factors for stroke, said Haseeb A. Rahman, MD, a neurology resident at Houston Methodist Hospital in Texas.
To evaluate how change in migraine severity with hormone replacement therapy affects risk of ischemic stroke, Dr. Rahman and colleagues at the Zeenat Qureshi Stroke Institute in Minneapolis analyzed data for 82,208 women, ages 50 to 79, who had migraine when they enrolled in the Women’s Health Initiative Study, which began in 1993. Approximately 45% of the participants were taking hormone replacement therapy (ie, estrogen or estrogen plus progesterone) at baseline.
At a three-year follow-up visit, the women completed a questionnaire to assess whether their migraines had worsened. During the 12-year study, 2,063 of the women had an ischemic stroke. The researchers found that women who were using hormone replacement therapy at study baseline and reported more severe migraine at three years were significantly more likely to have an ischemic stroke (odds ratio [OR], 1.3), compared with women who had never taken or no longer were taking hormone replacement therapy at baseline and experienced worsening migraine at three years (OR, 0.81).
Rapid Symptom Improvement May Not Mean Better Stroke Recovery
Patients with stroke whose motor symptoms quickly improve before hospital arrival do not necessarily have favorable outcomes, according to a study.
To examine how rapid improvement of stroke symptoms relates to recovery, Clotilde Balucani, MD, PhD, Research Assistant Professor of Neurology at the State University of New York Downstate Medical Center in Brooklyn, and colleagues analyzed data from the Field Administration of Stroke Therapy–Magnesium trial.
The investigators defined rapid neurologic improvement as a decrease of 2 or more points from prehospital Los Angeles Motor Scale score to Los Angeles Motor Scale score at hospitalization. They defined dramatic rapid neurologic improvement as a decrease of at least 4 points on the scale, which measures facial droop, hand grip, and arm strength.
The researchers included 1,700 patients with an average age of approximately 70. Most patients were white, and nearly half were female. More than three-fourths of patients had high blood pressure. The investigators found that 19% of subjects had rapid neurologic improvement and 6% of subjects had dramatic rapid neurologic improvement.After adjusting for covariates, patients with rapid neurologic improvement were 1.33 times more likely than patients without rapid improvement to have an excellent outcome (ie, modified Rankin Scale score of 0–1) at 90 days. Patients with rapid improvement were less likely to have high blood pressure and diabetes, compared with patients whose symptoms did not quickly improve.
Patients with rapid improvement or dramatic rapid neurologic improvement were more likely to be discharged home (53% and 64%, respectively), compared with patients whose symptoms did not rapidly improve (25%). The investigators noted that patients with rapid improvement who were not discharged home might have gone to facilities such as nursing homes or rehabilitation centers.
“Our data suggest that rapid neurologic improvement in the prehospital setting does not always translate to favorable outcome,” said the researchers. “Factors affecting outcome in rapid neurologic improvement need to be further explored.”
In addition, patients with rapid improvement “still need to be considered for therapy to dissolve blood clots, given the high rate of unfavorable outcome,” Dr. Balucani said.
Endovascular Treatment May Help Preserve Executive Function
Mechanically removing a clot in ischemic stroke may lead to better cognitive function, compared with medical therapy, according to an analysis of data from the REVASCAT trial.
The trial enrolled 206 patients with stroke of anterior circulation at less than eight hours after onset. Patients were randomized to receive thrombectomy or medical treatment and did not have cognitive impairment at onset. Investigators measured executive function using the Trail Making Test at 90 days.
On Part A of the Trail Making Test, which measures visual attention and processing speed, “completion in requested time was similar in both treatment arms,” said Elena López-Cancio, MD, PhD, of Hospital Germans Trias i Pujol in Barcelona, and colleagues. However, on Part B, a more challenging measure of executive functioning, 39 patients in the thrombectomy group (64% of those who completed the first test) versus 26 patients in the medication group (44% of those who completed the first test) completed the test. Patients who received medical treatment alone needed significantly more time to complete the second test.