The stroke risk of migraine in men appears to be less estab- lished. Randomized trial evidence that migraine prophylaxis decreases stroke risk is lacking. The significance of deep white matter lesions and other infarct-like lesions seen on MRI in patients with migraine remains unclear. No proven primary prevention strategy exists for patients with migraine. Closure of PFO for treatment of migraine and for primary or second- ary stroke prevention remains controversial, with no data from well-controlled studies showing benefit. Migraine: Recommendations 1. Smoking cessation should be strongly recommended in women with migraine headaches with aura (Class I; Level of Evidence B). 2. Alternatives to OCs, especially those containing estrogen, might be considered in women with active migraine headaches with aura (Class IIb; Level of Evidence B). 3. Treatments to reduce migraine frequency might be reasonable to reduce the risk of stroke (Class IIb; Level of Evidence C). 4. Closure of PFO is not indicated for preventing stroke in patients with migraine (Class III; Level of Evidence B). 