New recommendation Prophylactic carotid angioplasty and stenting might be considered in highly selected patients with asymptomatic carotid stenosis (minimum, 60% by angiography, 70% by validated Doppler ultrasound), but its effectiveness compared with medical therapy alone in this situation is not well established (Class IIb; Level of Evidence B). New recommendation In asymptomatic patients at high risk of complications for carotid revascularization by either carotid endarterectomy or carotid angioplasty and stenting, the effectiveness of revascularization versus medical therapy alone is not well established (Class IIb; Level of Evidence B). New recommendation Sickle cell disease Transcranial Doppler screening for children with sickle cell disease is indicated starting at 2 y of age and continuing annually to 16 y of age (Class I; Level of Evidence B). Slightly reworded to include up to 16 y (no change in class or LOE) In children at high risk for stroke who are unable or unwilling to be treated with periodic red cell transfusion, it might be reasonable to consider hydroxyurea or bone marrow transplantation (Class IIb; Level of Evidence B). Changed from LOE C to LOE B Migraine Smoking cessation should be strongly recommended in women with migraine headaches with aura (Class I; Level of Evidence B). New recommendation Alternatives to oral contraceptives, especially those containing estrogen, might be considered in women with active migraine headaches with aura (Class IIb; Level of Evidence B). New recommendation Table 5. Continued Section 2014 Recommendation Description of Change from 2011 (Continued) As health professionals, we must ensure that progress in pre- venting stroke does not lead to complacency.We must acknowl- edge that several recommendations remain vague because of suboptimal clinical trial evidence or, even more concerning, may be out of date and therefore irrelevant. 