BMJ 1999;318:1485 ( 29 May )

Letters

Migraine and stroke in young women

    Authors' results suggest that all types of migraine are contraindications to oral contraceptives
    Prospective study is needed to determine what clinical practice in migraine should be
    Authors' reply

Authors' results suggest that all types of migraine are contraindications to oral contraceptives

The first 150 words of the full text of this article appear below.

EDITOR---Chang et al report that the odds ratios for ischaemic stroke in young women with classical migraine (with aura) and simple migraine (without aura) were similar.1 These findings are at odds with earlier studies, which reported increased risk primarily in migraine with aura.2 We note that the 95% confidence interval for ischaemic stroke in migraine without aura included unity (odds ratio 2.97 (95% confidence interval 0.66 to 13.5), unlike that for migraine with aura (3.81 (1.26 to 11.5). 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. They characterised aura by at least one of the following symptoms just before or during the headache: visual disturbances or abnormalities of speech, skin sensation, or muscle power. Although their questionnaire was based on diagnostic criteria proposed by the International Headache Society, their questions were too non-specific.

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Relevant Article

Migraine and stroke in young women: case-control study
C L Chang, Michael Donaghy, and Neil Poulter
BMJ 1999 318: 13-18. [Abstract] [Full Text] [PDF]

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