Migraine treatment with triptans is contraindicated in patients with a history of cerebrovascular disease or coronary heart as explicitly stated in guidelines from the American Academy of Neurology. As for the risk of treatment with trip- tans in women with migraine with aura, there are no data to guide this decision other than the observational data related to higher risk of stroke among those who smoke cigarettes or use OCs (see Oral Contraceptives ). Given the number of stud- ies that consistently show a higher risk of stroke in younger women with migraine with aura, it may be reasonable to include this in a woman-specific risk profile. The general rec- ommendations for men and women with migraine with aura and stroke are as stated in the primary prevention guideline.19 Migraine With Aura: Recommendations 1. Because there is an association between higher migraine frequency and stroke risk, treatments to reduce migraine frequency might be reasonable, although evidence is lacking that this treatment reduces the risk of first stroke (Class IIb; Level of Evidence C). 2. Because of the increased stroke risk seen in women with migraine headaches with aura and smoking, it is reasonable to strongly recommend smoking cessation in women with migraine headaches with aura (Class IIa; Level of Evidence B). 