Selective screening based on prior personal or family history of VTE is proposed to be more cost-effective than universal screening in women who initiate OCs or desire to become pregnant.229 The cost- effectiveness analysis in this meta-analysis was designed for prevention of VTE, but adaptation to stroke screening in young women should also include obesity, diabetes mellitus, hyperlipidemia, hyperten- sion, and cigarette smoking. Another very important risk factor for stroke in young women is migraine aura, which has some evidence sup- porting a further increase in risk for women who also use OCs. An analysis of the Stroke Prevention in Young Women study, a population-based, case-control study of 386 women aged 15 to 49 years with incident stroke and 614 age- and ethnicity- matched control subjects, showed that women with probable migraine with visual aura were at 1.5-fold increased odds (95% CI, 1.1 2.0) of stroke compared with Women with this migraine type who also smoked cigarettes and used OCs had 7.0-fold higher odds (95% CI, 1.3 22.8) of stroke than women with probable migraine with visual aura who did not smoke or use OCs; however, women with probable migraine with visual aura who were OC users but nonsmokers did not have a signifi- cantly increased odds of stroke, which suggests the risk with both OC use and smoking in women with probable migraine with visual aura is additive.230 This was a biethnic cohort of black (representing a higher proportion of cases) and white women, whereas many of the large cohorts were limited to a northern European population. 