Less Well-Documented or Potentially Modifiable Risk Factors Migraine Migraine headache has been most consistently associated with stroke in young women, especially those with migraine with A meta-analysis of 21 studies (13 case-control and 8 cohort) reported an overall pooled RR of 2.04 (95% CI, 1.72 The risk was greater in migraine with aura (pooled adjusted OR for 7 studies, 2.51; 95% CI, 1.52 4.14) com- pared with the association of ischemic stroke and migraine without aura (pooled adjusted OR for 6 studies, 1.29; 95% A second meta-analysis of 9 studies (6 case- control and 3 cohort) reported a pooled RR of 1.73 (95% CI, 1.31 2.29) between any migraine and ischemic stroke.594 This study also found a significantly higher risk of stroke among individuals with migraine with aura (RR, 2.16; 95% CI, 1.53 3.03) compared with individuals with migraine with- out aura (RR, 1.23; 95% CI, 0.90 1.69; meta-regression for aura status, P=0.02).594 Furthermore, there was a significant risk among women (RR, 2.08, 95% CI, 1.13 3.84) but not among men (RR, 1.37; 95% CI, 0.89 2.11). Age <45 years, especially in women (RR, 3.65; 95% CI, 2.21 6.04), smoking CI, 1.51 32.68) further increased the risk.594 Both meta-anal- yses are in general agreement with prior studies.595 Counseling on possible alternative forms of birth control other than OCs in women with migraine may lower the risk of stroke, but this recommendation should be placed in the context of overall health implications of such a change. The WHS, a primary prevention trial of women 45 years of age and free of CVD at enrollment, continues to inform the association between women with migraine and stroke. 