Incidence of de novo migraine after premenopausal bilateral oophorectomy

Little is known about the effects of premenopausal bilateral oophorectomy on the development of migraine. We compared migraine outcomes for women undergoing oophorectomy with those of referent women.

The cohort included 1243 women who underwent premenopausal bilateral oophorectomy in Olmsted County, MN, US between 1988 and 2007 and 1415 age-matched (±1 year) referent women. Women diagnosed with migraine before oophorectomy (or index) were excluded. Estrogen therapy after oophorectomy was assessed as a time-dependent factor.

Women who underwent oophorectomy had an increased risk of de novo migraine compared with referent women (HR, 1.59; 95 % CI, 1.24-2.05). The risk was particularly higher for women who underwent oophorectomy under the age of 45 years. An increased risk of migraine without aura, but not of migraine with aura, was observed, as is characteristic of menstrual migraines. The risk of de novo migraine in the women with oophorectomy off estrogen was comparable to that of the referent women (HR, 0.80; 95 % CI, 0.43-1.52). By contrast, women with oophorectomy on estrogen had an increased risk of migraine (HR, 2.08; 95 % CI, 1.47-2.92).

Premenopausal bilateral oophorectomy is associated with an increased risk of migraine. Although estrogen is known to mitigate the severity of menopause-related symptoms, the higher risk for migraine among women using estrogen could be the result of them being prescribed estrogen because of greater severity of menopause symptoms. We encourage future studies to examine how the type, dose, and route of estrogen impact migraine outcomes after oophorectomy.