A meta-analysis of case-control studies of the association of migraine and patent foramen ovale

Takagi, Hisato; Umemoto, Takuya

doi:10.1016/j.jjcc.2015.09.016

Cited by 80 publications

(61 citation statements)

References 39 publications

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“…In a recent meta-analysis, PFO is associated with 2.5-fold increased prevalence for migraine and 3.4-fold increased prevalence migraine with aura [5]. In a cross sectional study, we have found increased prevalence of right-to-left shunts (RLs) (62.9% vs. 44.0%) and PFO (54.8% vs. 30.0%) in patients with migraine with aura (MA) compared with those with migraine without aura (MWOA) in Asian populations [6].…”

Section: Introductionmentioning

confidence: 99%

The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

et al. 2017

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BackgroundThere may be a link between right-to-left shunt (RLs) and brain white matter lesions (WMLs) in patients with migraine. In this study, we assessed the relationship between WMLs and RLs in Japanese migraine patients.MethodsA total of 107 consecutive patients with migraine with (MA) and without aura (MWOA) were included in this study. Contrast transcranial Doppler ultrasound was used to detect RLs. WMLs were graded using brain magnetic resonance imaging based on well-established criteria.FindingsThe prevalence of RLs was significantly increased in the WMLs positive group (n = 24) compared with the WMLs negative group (n = 83) (75.0% vs. 47.0%, p = 0.015). In prevalence of WMLs between MA and MWOA patients, there were no statistical differences (p = 0.410). Logistic regression analysis adjusted by age and disease duration of migraine identified an RLs-positive status as the sole determinant for the presence of WMLs (OR = 6.15; 95% CI 1.82–20.8; p = 0.003)ConclusionOur study suggests a possible link between RLs and WMLs in Japanese patients with migraine.

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Section: Introductionmentioning

confidence: 99%

The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

et al. 2017

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“…There may exist a common pathophysiology of increased ischemic stroke risk in young stroke population and older adults with late onset of MA as shown in our study, suggestive of underlying triggers such as microemboli responsible for MA symptoms. Additionally, our results are consistent with previous epidemiological studies, that MO is not a significant risk factor for ischemic stroke, when excluding stroke related to cervical artery dissection …”

Section: Discussionmentioning

confidence: 95%

Migraine Age of Onset and Association With Ischemic Stroke in Late Life: 20 Years Follow‐Up in ARIC

et al. 2019

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Background and Purpose To evaluate the association between cumulative exposure to migraine and incidence of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study. Methods In this ongoing, prospective longitudinal community‐based cohort, participants were interviewed to ascertain migraine history at the third visit (1993–1995), followed for ischemic stroke incidence over 20 years. We performed a post hoc analysis to evaluate the association between the age of migraine onset and ischemic stroke. Results We identified 447 migraineurs with aura (MA) and 1128 migraineurs without aura (MO) among 11,592 black and white participants. There was an association between the age of MA onset ≥50 years old (average duration = 4.75 years) and ischemic stroke when compared to no headache group (multivariable adjusted HR = 2.17, 95% CI [1.39–3.39], P < .001). MA onset <50 years old (average duration = 28.17 years) was not associated with stroke (multivariable adjusted HR = 1.31, 95% CI [0.86–2.02], P = .212). These results were consistent with our logistic regression model. MO was not associated with increased stroke regardless of the age of onset. The absolute risk for stroke in migraine with aura is 37/447 (8.27%) and migraine without aura is 48/1128 (4.25%). Conclusion As compared to the no headache participants, increased stroke risk in late life was observed in participants with late onset of MA. In this cohort, longer cumulative exposure to migraine with visual aura, as would be expected with early onset of migraine, was not associated with increased risk of ischemic stroke in late life. This study underscores the importance of the age of onset of MA in assessing stroke risk in older migraineurs.

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“…A recent meta-analysis of 21 randomized controlled trials confirmed that PFO is associated with 3.4-fold migraine with aura but that there is no association with migraine without aura [10]. Different pathophysiological mechanisms have been postulated like right-to-left shunting of small subclinical emboli and metabolites bypassing the pulmonary system and causing irritation of the trigeminal nerve or an increased platelet activation and aggregation in response to serotonin could possibly trigger migraine and aura (normally serotonin is metabolized in the pulmonary circulation by the lung monoamine oxidase) [11,12].…”

Section: Discussionmentioning

confidence: 99%

A Multidisciplinary Approach to a Complicated Acute Paradoxical Embolism via a Patent Foramen Ovale

Diebels

Wessels

Goovaerts³

et al. 2017

J Med Cases

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We report a case of a 43-year-old male with a history of migraine with aura and a heterozygous factor V Leiden deficiency presenting with a complicated paradoxical arterial embolism of a deep vein thrombosis via a patent foramen ovale (PFO). Recovery was complicated with a dropfoot due to a reperfusion compartment syndrome. Treatment involved a multidisciplinary approach including embolectomy, fasciotomy, percutaneous PFO closure and extensive rehabilitation. At 5-month follow-up, the patient reported significant improvement in pain, sensation, strength and function of his leg. Repeat electromyography showed reinnervation potentials and improvement of maximal contraction in muscles innervated by the tibial and peroneal nerve, where the latter was not fully restored; however, the patient was able to walk independently again without orthosis and had restarted working. In conclusion, a complicated paradoxical embolism should be treated in a multidisciplinary setting to optimize diagnostic approach, treatment and rehabilitation.

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A meta-analysis of case-control studies of the association of migraine and patent foramen ovale

Abstract: PFO is associated with 3.4-fold migraine-with-aura and 2.5-fold migraine-with/without-aura prevalence but unassociated with migraine-without-aura prevalence.

Cited by 80 publications

References 39 publications

The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

Migraine Age of Onset and Association With Ischemic Stroke in Late Life: 20 Years Follow‐Up in ARIC

A Multidisciplinary Approach to a Complicated Acute Paradoxical Embolism via a Patent Foramen Ovale

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