7
Table 14. Migraine
Recommendations
COR LOE
Smoking cessation should be strongly recommended in women with
migraine headaches with aura.
I B
Alternatives to OCs, especially those containing estrogen, might be
considered in women with active migraine headaches with aura.
IIb C
Treatments to reduce migraine frequency might be reasonable to
reduce the risk of stroke.
IIb C
Closure of PFO is NOT indicated for preventing stroke in patients
with migraine.
III B
Table 15. Metabolic Syndrome
Recommendation
Management of individual components of the metabolic syndrome is recommended,
including lifestyle measures (ie, exercise, appropriate weight loss, proper diet) and
pharmacotherapy (ie, medications for BP lowering, lipid lowering, glycemic control, and
antiplatelet therapy), as endorsed in other sections of this guideline. (Refer to relevant
sections for Class and Levels of Evidence for each recommendation.)
Table 16. Alcohol Consumption
Recommendations
COR LOE
Reduction or elimination of alcohol consumption in heavy
drinkers through established screening and counseling strategies as
described in the 2004 US Preventive Services Task Force update is
recommended.
I A
For individuals who choose to drink alcohol, consumption of ≤2
drinks per day for men and ≤1 drink per day for nonpregnant women
might be reasonable.
IIb B
Table 17. Drug Abuse
Recommendation
COR LOE
Referral to an appropriate therapeutic program is reasonable for
patients who abuse drugs that have been associated with stroke,
including cocaine, khat, and amphetamines.
IIa C
Table 18. Sleep-Disordered Breathing
Recommendations
COR LOE
Because of its association with stroke risk, screening for sleep apnea
through a detailed history, including structured questionnaires such
as the Epworth Sleepiness Scale and Berlin Questionnaire, physical
examination, and, if indicated, polysomnography may be considered.
IIb C
Treatment of sleep apnea to reduce the risk of stroke may be
reasonable, although its effectiveness for primary prevention of stroke
is unknown.
IIb C
