Migraine with Aura and New Stroke Prevention Guidelines for Women

Patient Expert

We've know for some time now that Migraine with aura increases the risk of stroke in women. The primary evidence has come from data from studies of women's health.

Now, _for the first time _, guidelines have been developed by the American Heart Association / American Stroke Association for preventing stroke in women, and these guidelines include a warning about Migraine with aura. Cheryl Bushnell, MD, lead author commented:

"If you are a woman, you share many of the same risk factors for stroke with men, but your risk is also influenced by hormones, reproductive health, pregnancy, childbirth and other sex-related factors."2

Dr. Bushnell also said More studies need to be done to develop a female-specific score to identify women at risk for stroke.

The guidelines outline stroke risks unique to women and provide scientifically-based recommendations on how best to treat them, including:

  • Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks.
  • Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
  • Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) may be considered for blood pressure medication, whereas expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
  • Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
  • _Women who have migraine with aura should stop smoking to avoid higher stroke risks _.
  • Women over age 75 should be screened for atrial fibrillation risks due to its link to higher stroke risk.

The American Heart Association / American Stroke Association has also prepared a helpful infographic about women's stroke risk:

(Click on the image for a slightly larger version.) ** Summary and comments:**

For all too long, health guidelines and other health information as well as many studies have been based on information for men and women together, failing to recognize and address how different men and women are. Symptoms, response to medications, and many other factors are dramatically different in women than in men. Kudos to the American Heart Association / American Stroke Association for developing these guidelines that are specific to women. This is the same association that sponsors Go Red for Women and other programs to educate and bring awareness to the risks women have for heart attack and the differences between men's and women's heart health. More organizations and indeed individual physicians and other health care professionals need to follow their lead.

Those of us who have Migraine with aura should not panic, but should view these new guidelines as more than sufficient reason to discuss our stroke risks with our physicians and work to reduce as many modifiable risks as possible. While we're discussing these guidelines with our physicians, we should also discuss our risks for heart attack.   Resources:

Busnhell, Cheryl, et. al. on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research. "Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association." Stroke. Published online February 6, 2014.

Press release. "New guidelines for reducing stroke risks unique to women." American Heart Association/American Stroke Association. February 6, 2014.

Walton, Alice G. "A Woman's Guide To Stroke Prevention." Forbes. February 7, 2014.

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