Praxis Medical Insights

The American Heart Association/American Stroke Association guidelines establish that women with migraine with aura develop infarct-like brain lesions at significantly elevated rates, even with infrequent attacks 1, 2, 3
Migraine with aura increases late-life infarct-like lesions (OR 1.4; 95% CI 1.1-1.8) regardless of attack frequency, according to the American Heart Association/American Stroke Association guidelines 1, 2
The CAMERA study found migraineurs with aura have dramatically higher prevalence of subclinical posterior circulation infarcts (OR 13.7; 95% CI 1.7-112) 1, 3
Female migraineurs face independently increased risk of white matter lesions (OR 2.1; 95% CI 1.0-4.1) 1, 3
Women with migraine with aura show particular association with cerebellar lesions (OR 1.9; 95% CI 1.4-2.6) 1, 2

Vascular Risk Factor Assessment

Migraine with aura associates with hypercoagulable states (OR 6.81; 95% CI 1.01-45.79 in patients <50 years with infarcts), according to the American Heart Association/American Stroke Association guidelines 1, 2

The American Heart Association/American Stroke Association guidelines recommend absolute contraindication to estrogen, as estrogen-containing contraceptives increase stroke risk (RR 7.02; 95% CI 1.51-32.68) 4
Smoking is prohibited due to catastrophic risk amplification (RR 9.03; 95% CI 4.22-19.34), according to the American Heart Association/American Stroke Association guidelines 4
Consider migraine prophylaxis with propranolol 80-160 mg daily or topiramate 50-100 mg daily to reduce future lesion accumulation, though evidence is indirect 5
Low-dose aspirin for primary stroke prevention in women with migraine with aura remains controversial but reasonable given lesion burden, according to the American Heart Association/American Stroke Association guidelines 1, 2