Migraines with aura have also been associated with a risk of hemorrhagic stroke in the WHS, but this association was stronger in the subset of women with fatal hemorrhagic stroke and in women <55 years of age.286 In pregnant women with an International Classification of Diseases, 9th Revision, hospi- tal code for migraine, there was a large association with hem- orrhagic stroke (OR, 9.1; 95% CI, 3.0 27.8); however, in the pregnant population, the risk of vascular diseases was closely associated with a concomitant diagnosis of preeclampsia/ Interestingly, there is an emerging literature on the asso- ciation between migraines and preeclampsia.288 290 The most recent analysis of the United Kingdom Obstetric Surveillance System found 30 cases of antenatal stroke, for an estimated incidence of 1.5 cases per 100000 women who delivered babies (95% CI, 1.0 2.1). Factors associated with increased risk of antenatal stroke were history of migraine (adjusted OR, 8.5; 95% CI, 1.5 62.1), gestational diabetes (adjusted OR, 26.8; 95% CI, 3.2 ), and preeclampsia or eclampsia Migraine With Aura: Summary and Gaps Migraine with aura (but not without aura) is associated with risk for IS and hemorrhagic stroke in women, especially those <55 years of age, although the absolute risk is low, and these women appear to have a good poststroke prognosis. Not only do the majority of studies with both men and women support this as a predominantly female issue, but the largest cohorts that have been studied are limited to women. There are not sufficient data to recommend specific approaches to treat migraine with the intention of lowering risk of stroke. 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. 