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1. Associated with an increased risk of ischemic stroke, especially in women who have recurrent headaches with aura.

2.  The AHA/ASA 2014 Guidelines for the Prevention of Stroke in Women recommend prophylaxis for women with frequent
migraines with aura if < 55 years and if they are taking oral contraceptives (OCPs ).

3.  This guideline also recommends aggressive smoking cessation efforts in women with migraine with aura.

4. Generally avoid OCPs in women who have migraine with aura (increased risk of stroke).

5. For other patients, the frequency of headache determines whether prophylaxis is needed; normally, the threshold is > 2-3 headaches per month.

6. There is usually a lag of 2-4 weeks between the start of prophylaxis and its effect.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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