severe headache with sudden onset and photophobia vertigo (central or peripheral) generalized dizziness and diaphoresis with or without hearing loss prevention although there is a lack of robust studies demonstrating the efficacy of lifestyle changes in preventing tia, many medical professionals recommend them. these include: avoiding smoking cutting down on fats to help reduce the amount of plaque buildup eating a healthy diet including plenty of fruits and vegetables limiting sodium in the diet, thereby reducing blood pressure exercising regularly moderating intake of alcohol, stimulants, sympathomimetics, etc. maintaining a healthy weight in addition, it is important to control any underlying medical conditions that may increase the risk of stroke or tia, including: hypertension high cholesterol diabetes mellitus atrial fibrillation treatment by definition, tias are transient, self-resolving, and do not cause permanent impairment. however, they are associated with an increased risk of subsequent ischemic strokes, which can be permanently disabling. therefore, management centers on the prevention of future ischemic strokes and addressing any modifiable risk factors. the optimal regimen depends on the underlying cause of the tia. lifestyle modification lifestyle changes have not been shown to reduce the risk of stroke after tia. while no studies have looked at the optimal diet for secondary prevention of stroke, some observational studies have shown that a mediterranean diet can reduce stroke risk in patients without cerebrovascular disease. a mediterranean diet is rich in fruits, vegetables and whole grains, and limited in red meats and sweets. vitamin supplementation has not been found to be useful in secondary stroke prevention. antiplatelet medications the antiplatelet medications, aspirin and clopidogrel, are both recommended for secondary prevention of stroke after high-risk tias. the clopidogrel can generally be stopped after 10 to 21 days. an exception is tias due to blood clots originating from the heart, in which case anticoagulants are generally recommended. after tia or minor stroke, aspirin therapy has been shown to reduce the short-term risk of recurrent stroke by 60–70%, and the long-term risk of stroke by 13%. the typical therapy may include aspirin alone, a combination of aspirin plus extended-release dipyridamole, or clopidogrel alone. clopidogrel and aspirin have similar efficacies and side effect profiles. clopidogrel is more expensive and has a slightly decreased risk of gi bleed. another antiplatelet, ticlopidine, is rarely used due to increased side effects. anticoagulant medications anticoagulants may be started if the tia is thought to be attributable to atrial fibrillation. atrial fibrillation is an abnormal heart rhythm that may cause the formation of blood clots that can travel to the brain, resulting in tias or ischemic strokes. atrial fibrillation increases stroke risk by five times, and is thought to cause 10-12% of all ischemic strokes in the us. anticoagulant therapy can decrease the relative risk of ischemic stroke in those with atrial fibrillation by 67% warfarin is a common anticoagulant used, but direct acting oral anticoagulants (doacs), such as apixaban, have been shown to be equally effective while also conferring a lower risk of bleeding. generally, anticoagulants and antiplatelets are not used in combination, as they result in increased bleeding risk without a decrease in stroke risk. however, combined antiplatelet and anticoagulant therapy may be warranted if the patient has symptomatic coronary artery disease in addition to atrial fibrillation. sometimes, myocardial infarction ("heart attack") may lead to the formation of a blood clot in one of the chambers of the heart. if this is thought to be the cause of the tia, people may be temporarily treated with warfarin or other anticoagulant to decrease the risk of future stroke. blood pressure control blood pressure control may be indicated after tia to reduce the risk of ischemic stroke. about 70% of patients with recent ischemic stroke are found to have hypertension, defined as systolic blood pressure (sbp) > 140 mmhg, or diastolic blood pressure (dbp) > 90 mmhg. until the first half of the 2010s, blood pressure goals have generally been sbp < 140 mmhg and dbp < 90 mmhg. however, newer studies suggest that a goal of sbp <130 mmhg may confer even greater benefit. blood pressure control is often achieved using diuretics or a combination of diuretics and angiotensin converter enzyme inhibitors, although the optimal treatment regimen depends on the individual. studies that evaluated the application of blood pressure‐lowering drugs in people who had a tia or stroke, concluded that this type of medication helps to reduce the possibility of a recurrent stroke, of a major vascular event and dementia. the effects achieved in stroke recurrence were mainly obtained through the ingestion of angiotensin-converting enzyme (ace) inhibitor or a diuretic. cholesterol control there is inconsistent evidence regarding the effect of ldl-cholesterol levels on stroke risk after tia. elevated cholesterol may increase ischemic stroke risk while decreasing the risk of hemorrhagic stroke. while its role in stroke prevention is currently unclear, statin therapy has been shown to reduce all-cause mortality and may be recommended after tia. diabetes control diabetes mellitus increases the risk of ischemic stroke by 1.5–3.7 times, and may account for at least 8% of first ischemic strokes. while intensive glucose control can prevent certain complications of diabetes such as kidney damage and retinal damage, there has previously been little evidence that it decreases the risk of stroke or death. however, data from 2017 suggests that metformin, pioglitazone and semaglutide may reduce stroke risk. surgery if the tia affects an area that is supplied by the carotid arteries, a carotid ultrasound scan may demonstrate stenosis, or narrowing, of the carotid artery. for people with extra-cranial carotid stenosis, if 70-99% of the carotid artery is clogged, carotid endarterectomy can decrease the five-year risk of ischemic stroke by approximately half. for those with extra-cranial stenosis between 50 and 69%, carotid endarterectomy decreases the 5-year risk of ischemic stroke by about 16%. for those with extra-cranial stenosis less than 50%, carotid endarterectomy does not reduce stroke risk and may, in some cases, increase it. the effectiveness of carotid endarterectomy or carotid artery stenting in reducing stroke risk in people with intra-cranial carotid artery stenosis is currently unknown. in carotid endarterectomy, a surgeon makes an incision in the neck, opens up the carotid artery, and removes the plaque occluding the blood vessel. the artery may then be repaired by adding a graft from another vessel in the body, or a woven patch. in patients who undergo carotid endarterectomy after a tia or minor stroke, the 30-day risk of death or stroke is 7%. carotid artery stenting is a less invasive alternative to carotid endarterectomy for people with extra-cranial carotid artery stenosis. in this procedure, the surgeon makes a small cut in the groin and threads a small flexible tube, called a catheter, into the patient's carotid artery. a balloon is inflated at the site of stenosis, opening up the clogged artery to allow for increased blood flow to the brain. to keep the vessel open, a small wire mesh coil, called a stent, may be inflated along with the balloon. the stent remains in place, and the balloon is removed. for people with symptomatic carotid stenosis, carotid endarterectomy is associated with fewer perioperative deaths or strokes than carotid artery stenting. following the procedure, there is no difference in effectiveness if you compare carotid endarterectomy and carotid stenting procedures, however, endarterectomy is often the procedure of choice as it is a safer procedure and is often effective in the longer term for preventing recurrent stroke. for people with asymptomatic carotid stenosis, the increased risk of stroke or death during the stenting procedure compared to an endarterectomy is less certain. people who undergo carotid endarterectomy or carotid artery stenting for stroke prevention are medically managed with antiplatelets, statins, and other interventions as well. prognosis without treatment, the risk of an ischemic stroke in the three months after a tia is about 20% with the greatest risk occurring within two days of the tia. other sources cite that 10% of tias will develop into a stroke within 90 days, half of which will occur in the first two days following the tia. treatment and preventative measures after a tia (for example treating elevated blood pressure) can reduce the subsequent risk of an ischemic stroke by about 80%. the risk of a stroke occurring after a tia can be predicted using the abcd² score. one limitation of the abcd² score is that it does not reliably predict the level of carotid artery stenosis, which is a major cause of stroke in tia patients. the patient's age is the most reliable risk factor in predicting any level of carotid stenosis in transient ischemic attack. the abcd2 score is no longer recommended for triage (to decide between outpatient management versus hospital admission) of those with a suspected tia due to these limitations. epidemiology with the difficulty in diagnosing a tia due to its nonspecific symptoms of neurologic dysfunction at presentation and a differential including many mimics, the exact incidence of the disease is unclear. it is currently estimated to have an incidence of approximately 200,000 to 500,000 cases per year in the us according to the american heart association. tia incidence trends similarly to stroke, such that incidence varies with age, gender, and different race/ethnicity populations. associated risk factors include age greater than or equal to 60, blood pressure greater than or equal to 140 systolic or 90 diastolic, and comorbid diseases, such as diabetes, hypertension, atherosclerosis, and atrial fibrillation. it is thought that approximately 15 to 30 percent of strokes have a preceding tia episode associated.