A lthough research linking cardiovascular disorders to geomagnetic activity during the past 40 years is accumulating, 1-7 robust evidence for the effect of geomagnetic activity (the earth's magnetic field) on stroke occurrence is lacking and remains a matter of controversy. 1,4,6,8 This is because most studies to date are complicated by significant methodological limitations: high likelihood of stroke misclassification and selection bias (eg, official mortality data are particularly inappropriate for studying determinants of stroke occurrence, or use of hospital-based data, including both incident and recurrent strokes in the analysis, inaccurate data on stroke onset, poor neuroimaging verification of stroke types [there are significant differences in the pathogenesis and determinants of different stroke pathological types]), arbitrary selection of a time lag between exposure and outcome (spurious associations), and small sample sizes (type I error). No reliable data exist on effects of geomagnetic activity on the risk of occurrence of different stroke pathological types in various population groups Background and Purpose-Although the research linking cardiovascular disorders to geomagnetic activity is accumulating, robust evidence for the impact of geomagnetic activity on stroke occurrence is limited and controversial. Methods-We used a time-stratified case-crossover study design to analyze individual participant and daily geomagnetic activity (as measured by Ap Index) data from several large population-based stroke incidence studies (with information on 11 453 patients with stroke collected during 16 031 764 person-years of observation) in New Zealand, Australia, United Kingdom, France, and Sweden conducted between 1981 and 2004. Hazard ratios and corresponding 95% confidence intervals (CIs) were calculated. Results-Overall, geomagnetic storms (Ap Index 60+) were associated with 19% increase in the risk of stroke occurrence (95% CI, 11%-27%). The triggering effect of geomagnetic storms was most evident across the combined group of all strokes in those aged <65 years, increasing stroke risk by >50%: moderate geomagnetic storms (60-99 Ap Index) were associated with a 27% (95% CI, 8%-48%) increased risk of stroke occurrence, strong geomagnetic storms (100-149 Ap Index) with a 52% (95% CI, 19%-92%) increased risk, and severe/extreme geomagnetic storms (Ap Index 150+) with a 52% (95% CI, 19%-94%) increased risk (test for trend, P<2×10). Conclusions-Geomagnetic storms are associated with increased risk of stroke and should be considered along with other established risk factors. Our findings provide a framework to advance stroke prevention through future investigation of the contribution of geomagnetic factors to the risk of stroke occurrence and pathogenesis. 9 To determine associations between stroke occurrence and geomagnetic activity, it is important that stroke is seen and studied in a population context as a large proportion of the burden of care for stroke is borne outside the hospital sector.9-11 Furthermore...