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Old 10-09-2012
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Arrow Gyrus Daily Questions; Internal Medicine #50

Which of the following statements regarding the long-term outcomes in individuals with severe migraines is true?
A. Factors such as cigarette smoking and hypertension have no modifying risk on the development of ischemic stroke in individuals who have migraine with aura.
B. In both women and men, migraine with aura is as-sociated with an increased risk of ischemic stroke.
C. Migraines generally persist unchanged in severity throughout life.
D. Migraine with or without aura is associated with an increased risk of subclinical posterior circulation in-farction on MRI.
E. Women on oral contraceptives who have migraines without aura should discontinue these medications because of a marked increased risk of ischemic stroke.
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B. In both women and men, migraine with aura is as-sociated with an increased risk of ischemic stroke.
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Would go with E
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B
Aura is significant for a particular area being affected by the vasodilation/vasospasm of migraine (you all know migraine is a dynamic process rather than a fix vasodilation or whatever)
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The answer is B. In both women and men, migraine with aura is as-sociated with an increased risk of ischemic stroke.

The peak prevalence of migraine headaches occurs in the
fourth to fifth decades of life. Many women experience decreased severity and frequency of headaches after menopause, and some individuals cease to have migraines as they age. Migraine has been demonstrated to be a risk factor for ischemic stroke in both men and women .

In addition, women who have migraine withaura appear to be at greater risk of ischemic stroke if they are concurrently taking oral contraceptives.

The American College of Gynecology has recommended that women who are >35 or have focal neurologic symptoms with their migraine attacks should not take oral contraceptives but low-dose contraceptive can otherwise be taken safely in women with migraine headaches.

Any risk factors that are known to increase stroke risk such as hypertension or cigarette smoking also contribute to stroke in individuals with migraine.

Interestingly, asymptomatic women with migraines have been shown to have a greater likelihood of white matter changes on MRI, and those with aura had a significant increased risk of subclinical posterior circulation infarcts
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