It is critical for physicians prescribing hormonal contraception to distinguish among common headache, migraine, and migraine with aura, to decide when the use of estrogen-containing contraception is appropriate. Key considerations include physician selection of appropriate candidates for initiation of hormone-containing contraceptives, and decision making about method continuation in patients complaining of headache while taking hormonal contraceptives. 2 Given the significant proportion of reproductive-age women affected by migraine, there are several clinical considerations that arise when considering hormonal contraceptives in this population. 1 During these reproductive years, hormonal contraception is the most prevalent form of birth control used, with 43% of contracepting US women using hormone-containing pills, patches, ring, shots, implants, or intrauterine devices. 1 The prevalence of migraine increases with age: 22% of women age 20 to 24 years, 28% age 25 to 29 years, 33% age 30 to 34 years, and as many as 37% of women age 35 to 39 years are affected. The study has not yet been published, but was presented at the American Stroke Association’s International Stroke Conference 2016 in February in Los Angeles, CA.Forty-three percent of women in the United States are affected by migraine. People with migraine and a stroke should be screened for hardening of blood vessels and irregular heartbeat-two factors linked to the mechanisms that cause cardio-embolic and thrombotic ischemic strokes. Stroke risk factors, including high blood pressure, diabetes, smoking, and high cholesterol, need to be treated. “If you get migraines with aura, make sure your stroke risk factors are assessed by your doctor,” Dr. This study, and previous studies linking migraine with stroke, have implications for medical care. ![]() “If we are going to prevent people with migraines with aura from having a stroke, it’s important to know what types of stroke they’re having and then be vigilant about it,” Dr. Souvik Sen, MD, MPH, study author and a neurologist at the University of South Carolina School of Medicine in Columbia, SC, provided a possible explanation for the findings: Because migraines alter the blood vessels in the brain, the greater incidence of strokes caused by clots in the heart or the brain’s blood vessels suggests that migraine also affects blood vessels in the heart and neck. Migraine with aura patients were twice as likely to have an ischemic stroke caused by a clot that develops in a clogged part of the blood vessel supplying blood to the brain (thrombotic stroke).Migraine with aura patients were 3 times more likely to have an ischemic stroke caused by a mass or a clot that forms in the heart, dislodges, and travels to the brain (cardio-embolic stroke).Migraine with aura patients were 2.4 times more likely to have an ischemic stroke. ![]() When they compared migraine with aura patients to those who had migraine without aura, researchers found: In this 25-year ongoing study of nearly 13,000 adults ages 45 to 64, researchers found that 817 participants had ischemic strokes-strokes that occur when a clot or a mass clogs a blood vessel, cutting off blood flow to brain cells. ![]() This research builds on previous studies regarding stroke and migraine, which has shown a higher rate of stroke among older migraineurs who smoke and women younger than 45, particularly if they smoke, have high blood pressure, or use oral contraceptives. People who have migraine with aura are more likely to have strokes caused by either a blood clot in the heart or a clot within the brain’s blood vessels compared to those who have migraine without aura, a new study indicates.
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