Migraine and stroke in young women. Authors' results suggest that all types of migraine are contraindications to oral contraceptives.

Chang et al. reported that the odds ratios for ischemic stroke in young women with classical migraine (with aura) and simple migraine (without aura) were similar. These findings are at odds with earlier studies which reported increased risk primarily in migraine with aura. It has been noted that the 95% confidence interval for ischemic stroke in migraine without aura included unity unlike that for migraine with aura. Therefore a lesser risk in migraine without aura is not excluded. Another possible reason for the apparent discrepancy is that the authors failed to identify true aura. Although their questionnaire was based on diagnostic criteria proposed by the International Headache Society their questions were too nonspecific. It is important to distinguish between the different types of migraine because according to the Faculty of Family Planning and Reproductive Health Care migraine with focal aura absolutely contraindicates combined oral contraceptives. However most young women with migraine of any type can be assured that the absolute risk of ischemic stroke is minimal. It is suggested though that those at specific risk should be identified and counseled so that they may choose an appropriate contraceptive and avoid other risk factors.