- A meta-analysis showed that the risk of ischaemic stroke in migraine sufferers who experience aura is twice that found in people without migraine (BMJ 2009; 339: b3914).
- The risk of stroke increases further in women with migraine with aura who also take the combined oral contraceptive pill (COCP).
- The absolute risk of stroke in women with migraine is still low: 17-19 per 100,000 women-years (J Fam Plann Reprod Health Care 2003;29:209-22).
- One review found evidence that migraine with aura is not only a risk factor for ischaemic stroke but also for MI and other ischemic vascular events (Curr Opin Neurol 2007; 20: 310-9).
- Migraine seems to affect neurovascular factors and substances that increase the risk of stroke during and in between migraine attacks. Migraine patients are more likely to have a patent foramen ovale, a well-known risk factor for stroke (Intern Emerg Med 2008; 3 Suppl 1:S9-16).
- Women who have migraine with aura should not take the COCP because the risk of stroke is unacceptably high (Headache 2005; 45: 224-31).
- Prescribing formularies states that the COCP should be avoided in women who have: migraine with aura; severe migraine lasting more than 72 hours despite treatment; or migraine treated with ergot derivatives.
- However, a recent BMJ editorial has stated that a blanket ban on prescribing the COCP to women with migraines with aura is hard to justify (BMJ 2009; 339: b4380).
- It has been recommended that clinicians have a heightened vigilance for modifiable cardiovascular risk factors in patients with migraines, especially those who experience aura. (Neurology 2009; 72: 1864-71).
- The UK Medical Eligibility Criteria (UKMEC) for combined oral contraceptive use state that migraine with aura at any age is a UKMEC Category 4 condition; this means that the COCP poses an unacceptable health risk and it should not be used (Faculty of Family Planning and Reproductive Health Care. First Prescription of Combined Oral Contraception, 2006).