reports and review of the literature. Cephalalgia 1987; 7:93. 68. Cuadrado MJ, Sanna G. Headache and systemic lupus erythematosus. Lupus 2003; 12:943. 69. Straube A, Padovan CS, F rderreuther S, Wick M. [Antinuclear and anticardiolipin antibodies in primary headache syndromes]. Schmerz 1998; 12:342. 70. Tietjen GE, Gottwald L, Al-Qasmi MM, et al. Migraine is associated with livedo reticularis: a prospective study. Headache 2002; 42:263. 71. Tietjen GE, Al-Qasmi MM, Shukairy MS. Livedo reticularis and migraine: a marker for stroke risk? Headache 2002; 42:352. 72. Rebollo M, Val JF, Garijo F, et al. Livedo reticularis and cerebrovascular lesions (Sneddon's syndrome). Clinical, radiological and pathological features in eight cases. Brain 1983; 106 ( Pt 4):965. 73. Martinelli A, Martinelli P, Ippoliti M, et al. Sneddon syndrome presenting with hemicranic attacks: a case report. Acta Neurol Scand 1991; 83:201. 74. Silva GS, Vicari P, Figueiredo MS, et al. Migraine-mimicking headache and sickle cell disease: a transcranial Doppler study. Cephalalgia 2006; 26:678. 75. Wolf ME, Szabo K, Griebe M, et al. Clinical and MRI characteristics of acute migrainous infarction. Neurology 2011; 76:1911. 76. Narbone MC, Leggiadro N, La Spina P, et al. Migraine stroke: a possible complication of both migraine with and without aura. Headache 1996; 36:481. 77. Rothrock J, North J, Madden K, et al. Migraine and migrainous stroke: risk factors and prognosis. Neurology 1993; 43:2473. https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 25/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate 78. Ebinger F, Boor R, Gawehn J, Reitter B. Ischemic stroke and migraine in childhood: coincidence or causal relation? J Child Neurol 1999; 14:451. 79. Dayno JM, Silberstein SD. Migraine-related stroke versus migraine-induced stroke. Headache 1997; 37:463. 80. 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Association of clinical headache features with stroke location: An MRI voxel-based symptom lesion mapping study. Cephalalgia 2018; 38:283. https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 26/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate 94. Seifert CL, Sch nbach EM, Magon S, et al. Headache in acute ischaemic stroke: a lesion mapping study. Brain 2016; 139:217. 95. Altiparmak T, Nazliel B, Caglayan HB, et al. Headache features of cerebellar ischemic strokes: Clinical and radiological-experiences of a single center. J Clin Neurosci 2021; 88:173. 96. Ferro JM, Melo TP, Oliveira V, et al. A multivariate study of headache associated with ischemic stroke. Headache 1995; 35:315. 97. Nardi K, Parnetti L, Pieri ML, et al. Association between migraine and headache attributed to stroke: a case-control study. Headache 2008; 48:1468. 98. Harriott AM, Karakaya F, Ayata C. 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J Vasc Surg 1987; 5:628. 104. Patel UK, Patel K, Malik P, et al. Stroke-like migraine attacks after radiation therapy (SMART) syndrome-a case series and review. Neurol Sci 2020; 41:3123. 105. Bruyn GW. Intracranial arteriovenous malformation and migraine. Cephalalgia 1984; 4:191. 106. Monteiro JM, Rosas MJ, Correia AP, Vaz AR. Migraine and intracranial vascular malformations. Headache 1993; 33:563. 107. Kraemer M, Lee SI, Ayzenberg I, et al. Headache in Caucasian patients with Moyamoya angiopathy - a systematic cohort study. Cephalalgia 2017; 37:496. 108. Lopez JI, Holdridge A, Chalela J. Headache and vasculitis. Curr Pain Headache Rep 2013; 17:320. 109. Younger DS. Headaches and vasculitis. Neurol Clin 2014; 32:321. https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 27/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate 110. Beuker C, Strunk D, Rawal R, et al. Primary Angiitis of the CNS: A Systematic Review and Meta-analysis. Neurol Neuroimmunol Neuroinflamm 2021; 8. 111. Salvarani C, Brown RD Jr, Calamia KT, et al. Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol 2007; 62:442. 112. Dichgans M, Mayer M, Uttner I, et al. The phenotypic spectrum of CADASIL: clinical findings in 102 cases. Ann Neurol 1998; 44:731. 113. Tan RY, Markus HS. CADASIL: Migraine, Encephalopathy, Stroke and Their Inter- Relationships. PLoS One 2016; 11:e0157613. 114. Haas DC. Arteriovenous malformations and migraine: case reports and an analysis of the relationship. Headache 1991; 31:509. 115. Sacco S, Ornello R, Ripa P, et al. Migraine and hemorrhagic stroke: a meta-analysis. Stroke 2013; 44:3032. 116. Kruit MC, van Buchem MA, Hofman PA, et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004; 291:427. 117. Scher AI, Gudmundsson LS, Sigurdsson S, et al. Migraine headache in middle age and late- life brain infarcts. JAMA 2009; 301:2563. 118. Bashir A, Lipton RB, Ashina S, Ashina M. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology 2013; 81:1260. 119. Kurth T, Tzourio C. Migraine and cerebral infarct-like lesions on MRI: an observation, not a disease. JAMA 2009; 301:2594. 120. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Brain stem and cerebellar hyperintense lesions in migraine. Stroke 2006; 37:1109. 121. Hamedani AG, Rose KM, Peterlin BL, et al. Migraine and white matter hyperintensities: the ARIC MRI study. Neurology 2013; 81:1308. 122. Medical eligibility for contraceptive use, 5th ed, World Health Organization, Geneva 2015 htt ps://www.who.int/publications/i/item/9789241549158 (Accessed on April 05, 2023). 123. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016; 65:1. 124. ACOG Practice Bulletin No. 206: Use of Hormonal Contraception in Women With Coexisting Medical Conditions: Correction. Obstet Gynecol 2019; 133:1288. 125. Sacco S, Merki-Feld GS, gidius KL, et al. Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). J Headache Pain 2017; 18:108. https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 28/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate 126. Wammes-van der Heijden EA, Rahimtoola H, Leufkens HG, et al. Risk of ischemic complications related to the intensity of triptan and ergotamine use. Neurology 2006; 67:1128. 127. Main ML, Ramaswamy K, Andrews TC. Cardiac arrest and myocardial infarction immediately after sumatriptan injection. Ann Intern Med 1998; 128:874. 128. Kato Y, Hayashi T, Mizuno S, et al. Triptan-induced Reversible Cerebral Vasoconstriction Syndrome: Two Case Reports with a Literature Review. Intern Med 2016; 55:3525. 129. Jayamaha JE, Street MK. Fatal cerebellar infarction in a migraine sufferer whilst receiving sumatriptan. Intensive Care Med 1995; 21:82. 130. Vijayan N, Peacock JH. Spinal cord infarction during use of zolmitriptan: a case report. Headache 2000; 40:57. 131. Aboul Nour H, Miller DJ, Danoun OA. Naratriptan-Associated Spinal Artery Infarction. Am J Ther 2021; 28:e734. 132. Kang DO, An H, Park GU, et al. Cardiovascular and Bleeding Risks Associated With Nonsteroidal Anti-Inflammatory Drugs After Myocardial Infarction. J Am Coll Cardiol 2020; 76:518. 133. Chua AL, Mehla S, Orlova YY. Drug Safety in Episodic Migraine Management in Adults. Part 2: Preventive Treatments. Curr Pain Headache Rep 2022; 26:493. 134. Orlova YY, Mehla S, Chua AL. Drug Safety in Episodic Migraine Management in Adults Part 1: Acute Treatments. Curr Pain Headache Rep 2022; 26:481. Topic 3344 Version 43.0 https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 29/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate GRAPHICS Brain MRI migrainous infarction Diffusion-weighted imaging lesion patterns of 11 patients with migrainous infarction. Patients 1 through 4 have multiple small lesions, patients 5 through 8 have isolated lesions in the posterior circulation territory, and patients 9 through 11 have isolated lesions in the middle cerebral artery territory. MRI: magnetic resonance imaging. Reproduced with permission from: Wolf ME, Szabo K, Griebe M, et al. Clinical and MRI characteristics of acute migrainous infarction. Neurology 2011; 76:1911. Copyright 2011 Lippincott Williams & Wilkins. https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 30/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Graphic 57203 Version 9.0 https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 31/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Clinical features of seizures, syncope, and other paroxysmal neurologic events in adults Clinical Recall of the Diagnostic Duration features event tools Focal seizure Initial symptoms depend on Usually <2 minutes; can be Variable depending on EEG may show interictal spikes location in brain; difficult to whether (poor sensitivity); motor and visual symptoms usually distinguish ictal from postictal consciousness is impaired ambulatory EEG if episodes are "positive" (eg, phase frequent enough; shaking, jerking, flashing lights, or visual distortion); MRI may show structural lesion may have anatomic "march" over seconds; some progress rapidly to GTC Generalized seizure Sudden alteration or loss of consciousness without warning; <5 minutes (for GTC); <1 minute for absence Complete amnesia; patient may recall initial focal symptoms EEG may show generalized spike- and-wave characteristic of some have myoclonic jerks or staring; tongue- biting and urinary incontinence may occur (for GTC) specific syndrome; MRI usually normal for generalized epilepsy syndromes, may show structural lesion if focal onset Psychogenic nonepileptic Fluctuating, asynchronous Rarely <1 minute; often prolonged Variable Video-EEG monitoring seizure motor activity, often with eye (>30 minutes) closure, side-to- side head or body movements, pelvic thrusting; most occur in front of a witness; fully or partially https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 32/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate alert despite bilateral motor activity; tongue- biting is rare Syncope Transient loss of 1 to 2 minutes Patient can recall ECG; consciousness resulting in loss of prodromal symptoms, if echocardiography if structural postural tone; present; lack of cardiac disease is prodrome of lightheadedness, warning may suggest cardiac suspected; ambulatory ECG warm or cold feeing, sweating, source monitoring if arrhythmia is palpitations, pallor; myoclonic suspected; orthostatic blood jerks or tonic pressure posturing may occur, especially if patient is kept measurements upright; no or minimal post- event confusion Transient ischemic attack (TIA) Rapid loss of neurologic function due to interrupted blood flow; symptoms depend on Several minutes to a few hours Usually complete unless language areas involved MRI/MRA, CTA, vascular risk factors vascular territory but are typically "negative" (eg, weakness, numbness, aphasia, visual loss); intensity is usually maximal at onset; consciousness usually preserved Migraine aura Positive and/or negative Up to 1 hour Complete Personal or family history of neurologic symptoms, most migraine often visual and sensory, evolving gradually over 5 https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 33/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate minutes (slower onset than TIA or focal seizure); slow spread of positive followed by negative symptoms, if present, is very characteristic; usually followed by headache Panic attack Palpitations, Minutes to hours Complete History of anxiety dyspnea, chest pain, or depressive symptoms, lightheadedness, triggering events sense of impending doom; associated or stressors hyperventilation may result in perioral and distal limb paresthesias Transient global amnesia Prominent anterograde amnesia (inability to form new memories) and 1 to 10 hours (mean 6 hours) Complete amnesia for the main episode; retrograde amnesia resolves Clinical diagnosis; negative MRI and toxicology screens variable retrograde amnesia; patient is disoriented in time, asking within 24 hours repetitive questions; other cognitive and motor functions spared; rare in adults younger than 50 years GTC: generalized tonic-clonic; EEG: electroencephalography; MRI: magnetic resonance imaging; ECG: electrocardiogram; MRA: magnetic resonance angiography; CTA: computed tomography angiography. Graphic 111740 Version 3.0 https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 34/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Comparison of effectiveness of contraceptive methods Other methods of contraception: Lactational amenorrhea method LAM is a highly effective, temporary method of contraception Emergency contraception Emergency contraceptive pills or an IUD (copper or LNG) after unprotected intercourse substantially reduces risk of pregnancy LNG: levonorgestrel. Adapted from: U.S. Selected Practice Recommendations for Contraceptive Use, 2013: Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition. MMWR Morb Mortal Wkly Rep 2013; 62:1. Additional information from: https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 35/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate 1. Trussell J, Aiken ARA, Mickes E, Guthrie K. E cacy, Safety, and Personal Considerations. In: Contraceptive Technology, 21st ed, Hatcher RA, Nelson AL, Trussell J, et al (Eds), Ayer Company Publishers, Inc., New York 2018. Graphic 57795 Version 10.0 https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 36/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Selected hormonal contraceptives: Oral contraceptives (birth control pills) and other delivery methods Estrogen United States Progestin (mg)* Notes (micrograms) brand name Monophasic combinations Drospirenone (3) Ethinyl estradiol Also approved for acne and Beyaz (20) premenstrual dysphoric disorder. Jasmiel Lo- In patients with conditions requiring Zumandimine chronic therapy with medications that may increase potassium, monitor serum potassium during the first treatment cycle and periodically Loryna Nikki Vestura thereafter if patient begins medication or develops a condition Yaz that increases risk for hyperkalemia. Packaged as active tablets for 24 days and placebo for 4 days; except Beyaz, which contains 451 mcg of levomefolate per tablet (24 active tablets and 4 levomefolate tablets). Levonorgestrel (0.09) Ethinyl estradiol (20) Amethyst Dolishale Levonorgestrel (0.1) Ethinyl estradiol (20) Packaged as active tablets for 21 days and placebo for 7 days. Afirmelle Aubra EQ Aviane Balcoltra Delyla Falmina Lessina Lutera Sronyx Tyblume Vienva https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 37/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Norethindrone acetate (1) Ethinyl estradiol (20) Packaged as active pills for 24 days and ferrous fumarate for 4 days. Aurovela 24 FE Blisovi 24 Fe Charlotte 24 Fe chewable tablets Finzala chewable tablets Gemmily capsules Hailey 24 Fe Junel Fe 24 Larin 24 Fe Merzee capsules Mibelas 24 Fe chewable tablets Microgestin 24 Fe Minastrin 24 Fe chewable tablets Tarina 24 Fe Taysofy capsules Taytulla capsules https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 38/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Packaged as active tablets for 21 days and ferrous fumarate for 7 days. Aurovela FE 1/20 Blisovi FE 1/20 Hailey FE 1/20 Junel FE 1/20 Larin Fe 1/20 Loestrin Fe 1/20 Microgestin FE 1/20 Tarina FE 1/20 EQ Packaged as active tablets for 21 Aurovela 1/20 days (does not contain iron). Junel 1/20 Larin 1/20 Loestrin 1/20 Microgestin 1/20 Norethindrone (0.8) Ethinyl estradiol (25) Packaged as active tablets for 24 days and ferrous fumarate for 4 days. Generess FE chewable tablets Kaitlib Fe chewable tablets Layolis FE chewable tablets Desogestrel (0.15) Ethinyl estradiol (30) Packaged as active tablets for 21 days and placebo for 7 days. Apri Cyred Cyred EQ Enskyce Isibloom Juleber Kalliga Reclipsen Drospirenone (3) Ethinyl estradiol (30) In patients with conditions requiring chronic therapy with medications Ocella Safyral that may increase potassium, monitor serum potassium during the Syeda Tydemy first treatment cycle and periodically Yasmin thereafter if patient begins https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 39/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Zumandimine medication or develops a condition that increases risk for hyperkalemia. Packaged as active tablets for 21 days and placebo for 7 days; except Safyral and Tydemy, which contain 451 mcg of levomefolate per tablet (21 active tablets and 7 levomefolate tablets). Levonorgestrel Ethinyl estradiol Packaged as active tablets for 21 Altavera (0.15) (30) days and placebo for 7 days. Ayuna Chateal EQ Kurvelo Levora 0.15/30 Marlissa Portia-28 Norethindrone acetate (1.5) Ethinyl estradiol (30) Packaged as active tablets for 21 days and ferrous fumarate for 7 days. Aurovela Fe 1.5/30 Blisovi Fe 1.5/30 Junel FE 1.5/30 Hailey FE 1.5/30 Larin Fe 1.5/30 Loestrin Fe 1.5/30 Microgestin FE 1.5/30 Packaged as active tablets for 21 days (does not contain iron). Aurovela 1.5/30 Junel 1.5/30 Hailey 1.5/30 Larin 1.5/30 Loestrin 1.5/30 Microgestin 1.5/30 Norgestrel (0.3) Ethinyl estradiol Packaged as active tablets for 21 Cryselle-28 (30) days and placebo for 7 days. Elinest Low-Ogestrel Ethynodiol diacetate (1) Ethinyl estradiol (35) Packaged as active tablets for 21 days and placebo for 7 days. Kelnor 1/35 Zovia 1/35 https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 40/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Norethindrone (0.4) Ethinyl estradiol (35) Packaged as active tablets for 21 days and placebo for 7 days. Balziva Briellyn Philith Vyfemla Packaged as active tablets for 21 days and ferrous fumarate for 7 days. Wymzya Fe chewable tablets Norethindrone Ethinyl estradiol Packaged as active tablets for 21 Necon 0.5/35 (28) (0.5) (35) days and placebo for 7 days. Nortrel 0.5/35 (28) Wera Norethindrone (1) Ethinyl estradiol (35) Packaged as active tablets for 21 days and placebo for 7 days. Alyacen 1/35 Dasetta 1/35 Nortrel 1/35 (28) Nortrel 1/35 is also available as a 21- day regimen (packaged without placebo). Nylia 1/35 Pirmella 1/35 Norgestimate (0.25) Ethinyl estradiol (35) Packaged as active tablets for 21 days and placebo for 7 days. Estarylla Femynor Mili Mono-Linyah Nymyo Sprintec 28 VyLibra Cyproterone (2) Ethinyl estradiol (35) Labeled approval in Canada is for treatment of acne; provides reliable contraception if taken as Cleo-35 Cyestra-35 Diane-35 recommended for treatment of acne. Packaged as active tablets for 21 days. Not available in the United States; Canadian product shown. Ethynodiol diacetate (1) Ethinyl estradiol (50) Packaged as active tablets for 21 days and placebo for 7 days. Kelnor 1/50 NOTE: Pills containing 50 mcg of ethinyl estradiol are not indicated for routine contraceptive use because of increased risk of https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 41/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate cardiovascular events compared with lower-dose oral contraceptive pills. Drospirenone (3) Estetrol (14.2) Packaged as active tablets for 24 days and placebo for 4 days. Nextstellis NOTE: Estetrol strength listed in In patients with conditions requiring milligrams (mg) chronic therapy with medications that may increase potassium, monitor serum potassium during the first treatment cycle and periodically thereafter if patient begins medication or develops a condition that increases risk for hyperkalemia. Nomegestrol Estradiol (as Packaged as active tablets for 24 Zoely acetate (2.5) hemihydrate) (1.5) days and placebo for 4 days. NOTE: Estradiol strength listed in milligrams (mg) Not available in the United States; United Kingdom and European Union product shown. Multiphasic combinations Dienogest (0,2,3,0) Estradiol valerate (3,2,2,1) Packaged as active tablets for 26 days and placebo for 2 days. Natazia NOTE: Estradiol strength listed in milligrams (mg) Norethindrone acetate (1,0) Ethinyl estradiol (10,10) Packaged as active tablets for 26 days and ferrous fumarate for 2 days. Lo Loestrin Fe Desogestrel Ethinyl estradiol Packaged as active tablets for 26 Azurette (0.15,0,0) (20,0,10) days and placebo for 2 days. Kariva Mircette Pimtrea Simliya Viorele Volnea Norethindrone acetate (1,1,1) Ethinyl estradiol (20,30,35) Also approved for acne. Tilia Fe Tri-Legest Fe Packaged as active tablets for 21 days and ferrous fumarate for 7 days. Norgestimate Ethinyl estradiol Packaged as active tablets for 21 Tri-Lo-Estarylla (0.18,0.215,0.25) (25,25,25) days and placebo for 7 days. Tri-Lo-Marzia Tri-Lo-Mili https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 42/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Tri-Lo-Sprintec Tri-Vylibra Lo Desogestrel (0.1,0.125,0.15) Ethinyl estradiol (25,25,25) Packaged as active tablets for 21 days and placebo for 7 days. Velivet Levonorgestrel (0.05,0.075,0.125) Ethinyl estradiol (30,40,30) Packaged as active tablets for 21 days and placebo for 7 days. Enpresse-28 Levonest Trivora (28) Norgestimate Ethinyl estradiol Also approved for acne. Tri-Estarylla (0.18,0.215,0.25) (35,35,35) Tri-Linyah Packaged as active tablets for 21 Tri-Mili days and placebo for 7 days. Tri-Nymyo Tri-Sprintec Tri-VyLibra Norethindrone (0.5,0.75,1) Ethinyl estradiol (35,35,35) Packaged as active tablets for 21 days and placebo for 7 days. Alyacen 7/7/7 Dasetta 7/7/7 Nortrel 7/7/7 Nylia 7/7/7 Pirmella 7/7/7 Norethindrone (0.5,1,0.5) Ethinyl estradiol (35,35,35) Packaged as active tablets for 21 days and placebo for 7 days. Aranelle Leena Extended combinations (91-day regimens) Levonorgestrel (0.1,0) Ethinyl estradiol (20,10) Packaged as a 91-day regimen: 84 days of the combination and 7 days Camrese Lo LoJaimiess of 10 mcg ethinyl estradiol only. LoSeasonique Levonorgestrel (0.15,0.15,0.15,0) Ethinyl estradiol (20,25,30,10) Packaged as a 91-day regimen: 84 days of the combination and 7 days Fayosim Quartette of 10 mcg ethinyl estradiol only. Rivelsa Levonorgestrel (0.15,0) Ethinyl estradiol (30,10) Packaged as a 91-day regimen: 84 days of the combination and 7 days Amethia Ashlyna of 10 mcg ethinyl estradiol only. Camrese Daysee Jaimiess Seasonique Simpesse Levonorgestrel (0.15) Ethinyl estradiol (30) Packaged as a 91-day regimen: active tablets for 84 days and placebo for 7 Introvale Iclevia days. https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 43/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Jolessa Setlakin Continuous combinations May use any monophasic 21/7 combination (eg, Amethyst [levonorgestrel 0.09 mcg-ethinyl estradiol 20 mcg]) by taking active hormone pills for 28 or more days continuously. Any progestin may be used, and higher doses of ethinyl estradiol may be used in some women. Refer to UpToDate topic. Progestin-only Norethindrone (0.35) None Packaged as active tablets for 28 days. Camila Deblitane Errin Heather Incassia Jencycla Lyleq Lyza Nora-BE Norlyroc Sharobel Drospirenone (4) None Packaged as active tablets for 24 days and placebo for 4 days. Slynd In patients with conditions requiring chronic therapy with medications that may increase potassium, monitor serum potassium during the first treatment cycle and periodically thereafter if patient begins medication or develops a condition that increases risk for hyperkalemia. Norgestrel None Packaged as active tablets for 28 Opill (0.075) days. Not in production globally but in review for over-the-counter use in the United States. Desogestrel (0.075) None Packaged as active tablets for 28 days. Cerazette Cerelle Hana Not available in the United States or Canada; United Kingdom product Lovima shown. Zelleta Transdermal patch, weekly https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 44/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Norelgestromin (releases 0.15 Ethinyl estradiol (releases 35 May have diminished efficacy in women 90 kg. Xulane Zafemy mg/day) mcg/day) A new patch is applied every 7 days for 3 weeks followed by a patch-free week. These products are therapeutically equivalent to Ortho Evra patch, which is no longer available in the United States. Levonorgestrel Ethinyl estradiol Contraindicated in women with BMI 30 kg/m due to decreased efficacy and increased risk of VTE. Diminished Twirla 2 (releases 0.12 mg/day) (releases 30 mcg/day) efficacy was observed in women with 2 BMI 25 kg/m . A new patch is applied every 7 days for 3 weeks followed by a patch-free week. Vaginal ring, monthly Etonogestrel (releases 0.12 mg/day) Ethinyl estradiol (releases 15 mcg/day) Ring is inserted for 3 weeks followed by 1 week without ring in place. A new ring is inserted 7 days after the last was removed. NuvaRing EluRyng Haloette Segesterone (releases 0.15 Ethinyl estradiol (releases 13 Ring is inserted for 3 weeks followed by 1 week without ring in place. The Annovera mg/day) mcg/day) ring is then reinserted for the first 21 days of subsequent 28-day cycles. One system provides contraception for 13 28-day cycles (1 year). Not yet adequately evaluated in women with 2 BMI >29 kg/m . Oral and IUD emergency contraceptive options are listed in a table that is available separately in UpToDate. Generic (non-branded) products are also available for most combination oral contraceptives in the United States. Descriptions are for US-available products unless noted otherwise. Consult local product information before use. Fe: contains iron; BMI: body mass index; VTE: venous thromboembolism; IUD: intrauterine device. Different progestins are not equivalent on a milligram basis. Refer to the UpToDate overview of combined hormonal contraceptives for guidance on selection. https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 45/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate The progestin norgestrel contains two isomers; only levonorgestrel is bioactive. The amount of norgestrel in each tablet is twice the amount of levonorgestrel. Adapted from: 1. The Medical Letter on Drugs and Therapeutics, October 8, 2018; Vol. 60 (1557): 161-168. 2. The Medical Letter on Drugs and Therapeutics, May 15, 2023; Vol. 65 (1676): 73-82. 3. Lexicomp online. Copyright 1978-2023 by Lexicomp, Inc. All rights reserved. Graphic 69223 Version 49.0 https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 46/47 7/6/23, 12:30 PM Migraine-associated stroke: risk factors, diagnosis, and prevention - UpToDate Contributor Disclosures Muhammad Ramzan, MD No relevant financial relationship(s) with ineligible companies to disclose. Sandhya Mehla, MD No relevant financial relationship(s) with ineligible companies to disclose. Jerry W Swanson, MD, MHPE Other Financial Interest: Elsevier [Honorarium as editor of texts about migraine]. All of the relevant financial relationships listed have been mitigated. Scott E Kasner, MD Grant/Research/Clinical Trial Support: Bayer [Stroke]; Bristol Meyers Squibb [Stroke]; Medtronic [Stroke]; WL Gore and Associates [Stroke]. Consultant/Advisory Boards: Abbvie [Stroke]; AstraZeneca [Stroke]; BMS [Stroke]; Diamedica [Stroke]; Medtronic [Stroke]. All of the relevant financial relationships listed have been mitigated. Richard P Goddeau, Jr, DO, FAHA No relevant financial relationship(s) with ineligible companies to disclose. Kristen Eckler, MD, FACOG No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/migraine-associated-stroke-risk-factors-diagnosis-and-prevention/print 47/47