Migraine with Aura Stroke Prevention

Epilepsy and headache, including migraine with aura, have a complex relationship that involves both bidirectional interactions and shared pathophysiological mechanisms. As a result, patients with these conditions often share similar risk factors for ischemic stroke. In fact, studies have shown that women with migraine with aura are at an increased risk of developing ischemic stroke.

To minimize this risk, it is essential to avoid certain substances and behaviors, such as smoking, using ergot alkaloids, and taking certain medications like combined oral contraceptives (OCPs). Additionally, progestin-only or nonhormonal contraceptive methods may be recommended for patients with migraine with focal neurological signs, those over 35 years of age, and smokers.

The American College of Obstetricians and Gynecologists guidelines emphasize the importance of careful follow-up and communication regarding contraceptive choices to prevent both ischemic stroke and unintended pregnancy. This is particularly critical in women with multiple risk factors for stroke, such as migraine with aura, diabetes, hyperlipidemia, hypertension, smoking, or obesity.

While some studies suggest that combined OCPs may increase the risk of ischemic stroke in patients with migraine with aura, others have found no contraindications to their use. The International Headache Society guidelines recommend considering the constellation of stroke risk factors in concert with OCP formulation to determine individual stroke risk and the best contraceptive to reduce that risk.

In conclusion, preventing ischemic stroke in patients with migraine with aura requires a comprehensive approach that takes into account multiple risk factors and the formulation of combined oral contraceptives. By understanding these complex relationships and taking proactive steps to minimize stroke risk, healthcare providers can help their patients manage their condition effectively and improve their overall quality of life.

Migraine with aura stroke prevention