Stroke in combined hormonal contraceptive users treated with triptans

Area of Science:

• Reproductive Health
• Neurology
• Pharmacology

Background:

• Combined hormonal contraceptives (CHC) are widely used by women of reproductive age.
• Triptans are common migraine treatments.
• The combined risk of stroke associated with CHC and triptan use is not well-established.

Purpose of the Study:

• To determine the prevalence of triptan use among Danish CHC users.
• To investigate the association between triptan use and the risk of ischemic (IS) and hemorrhagic (ICH) stroke in CHC users.

Main Methods:

• Historical cohort study using Danish national registries (2004-2021).
• Inclusion of women aged 18-49 years using CHCs.
• Poisson regression analysis to calculate incidence rate ratios (IRR) and differences (IRD) for stroke, adjusting for covariates.

Main Results:

• Over 1.7 million women studied; 57% used CHCs, with 10% of CHC users also prescribed triptans.
• CHC users who were prescribed triptans showed a 1.60-fold increased risk of IS compared to CHC users without triptan use (IRR 1.60).
• The risk of IS was elevated even when compared to women using neither CHCs nor triptans (IRR 2.61); no increased risk for ICH was observed.

Conclusions:

• Triptan use is a significant risk factor for ischemic stroke among combined hormonal contraceptive users.
• While the absolute risk of stroke remains low, it is notably higher in older CHC users who also use triptans.
• Healthcare providers should consider triptan use as a risk factor for IS when prescribing CHCs, especially for migraine sufferers.