
Migraine, Estrogen, and Pregnancy Shape Stroke Risk in Women
Rodica Di Lorenzo, MD, explains why new headaches, migraine with aura, estrogen exposure, smoking, and pregnancy matter in stroke assessment.
Migraine history requires specificity. Clinicians should distinguish migraine with aura from migraine without aura and ask whether the current headache differs from the patient’s established pattern. The CDC’s 2024 US Medical Eligibility Criteria classifies combined hormonal contraceptive use as category 4—an unacceptable health risk—for patients with migraine with aura. It also states that any new headache or marked change in headache should be evaluated.¹
In practice, clinicians should document aura status, contraceptive formulation, smoking, blood pressure, obesity,
In the video above, Di Lorenzo gives a focused reminder to PCPs: common diagnoses such as migraine should remain diagnoses of fit. When the pattern changes or vascular and reproductive risks accumulate, stroke and other cerebrovascular emergencies need to move higher on the differential.
Di Lorenzo has no relevant disclosures.
References
1. Centers for Disease Control and Prevention. Appendix D: Classifications for Combined Hormonal Contraceptives. US Medical Eligibility Criteria for Contraceptive Use, 2024. Updated November 19, 2024.
2. Centers for Disease Control and Prevention. About Pregnancy and Stroke. Updated May 19, 2026. Accessed September 14, 2026.
3. Miller EC, Bello NA, Chen PR, et al. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement From the American Heart Association and American Stroke Association. Stroke. 2026;57:e127-e145.












































































































