Treatment
Oral Contraceptives (OCs)
Î OCs may be harmful in women with additional risk factors (eg, cigarette
smoking, prior thromboembolic events) (III-B).
Î Among OC users, aggressive therapy for stroke risk factors may be
reasonable (IIb-C).
Î Routine screening for prothrombotic mutations before initiation of
hormonal contraception is not useful (III-A).
Î Measurement of BP before initiation of hormonal contraception is
recommended (I-B).
Postmenopausal HT
Î HT (CEE with or without medroxyprogesterone) should NOT be used for
primary or secondary prevention of stroke in postmenopausal women (III-A).
Î Selective estrogen receptor modulators, such as raloxifene, tamoxifen, or
tibolone, should NOT be used for primary prevention of stroke (III-A).
Migraine With Aura
Î Because there is an association between higher migraine frequency and
stroke risk, treatments to reduce migraine frequency might be reasonable,
although evidence is lacking that this treatment reduces the risk of first
stroke (IIb-C).
Î Because of the increased stroke risk seen in women with migraine
headaches with aura and smoking, it is reasonable to strongly recommend
smoking cessation in women with migraine headaches with aura (IIa-B).
Obesity, Metabolic Syndrome, and Lifestyle Factors
Î A healthy lifestyle consisting of regular physical activity, moderate alcohol
consumption (<1 drink/d for nonpregnant women), abstention from
cigarette smoking, and a diet rich in fruits, vegetables, grains, nuts, olive
oil, and low in saturated fat (such as the DASH [Dietary Approaches to
Stop Hypertension] diet) is recommended for primary stroke prevention in
women with cardiovascular risk factors (I-B).
Î Lifestyle interventions focusing on diet and exercise are recommended for
primary stroke prevention among individuals at high risk for stroke (I-B).
