A Thromboembolic Predisposition and the Effect of Anticoagulants on Migraine

Abstract

Objective.-To investigate the presence of thromboembolic risk factors and the effect of low-dose acenocoumarol therapy on migraine in patients who spontaneously reported a reduction of their migraine attacks during previous therapeutic use of anticoagulants.Background.-The positive effect of anticoagulants on migraine has been described in case reports and observational studies. It remains unclear whether this concerns only a select group of migraineurs with certain common characteristics.Methods. Results.-All patients had one or more thromboembolic risk factors. Two patients, both with factor V Leiden heterozygosity, experienced a clear improvement of migraine during low-dose acenocoumarol therapy.Conclusions.-Our findings support the hypothesis that migraine, as a phenotype, has different underlying mechanisms, amongst which a thromboembolic tendency. In this group of patients, oral anticoagulants may be a suitable form of migraine prophylaxis, but this needs further clinical investigation. Key words: migraine, migraine prophylaxis, anticoagulants, acenocoumarol, thromboembolic predisposition, hemostasisAbbreviations: INR international normalization ratio (Headache 2004;44:399-402) During the last decade, attention has been given to the increased risk for ischemic events in patients with migraine. Crassard et al reviewed the contribution of hemostasis to the ischemic risk in patients with migraine, particularly with regard to platelet hyperaggregability, antiphospholipid antibodies, and

Warfarin prophylaxis in migraine without aura but not in primary exercise headache

“…MO and other unspecified non-migrainous headaches have been considered in one study [3], while an improvement in MO, migraine with aura, hemiplegic migraine and chronic cluster headache has been sporadically documented [2,[5][6][7]. However, warfarin seems to be principally effective in reducing the frequency of migraine rather of other primary headaches [2,3].…”

“…Despite the absence of controlled studies, improvement of migraine has been reported after the introduction of anticoagulant therapy, needed for a requiring intercurrent condition [1][2][3].…”

Antithrombotic Therapy for Stroke in Young Adults

“…A recent, small, open-label study by Wammesvan der Heijden et al suggests that some patients with thrombophilic risk factors may actually experience an improvement of migraine symptoms with low-dose anticoagulation [39]. What is not known is whether routine migraine prophylaxis, or the use of antiplatelet agents, will lower the risk of further asymptomatic CNS lesions or actual ischemic events [40].…”

A Case of Migraine With Aura Resolving on Warfarin But Not on Apixaban

“…Migraines are associated with hypercoagulable states, with an estimated 1.2‐ to 2.2‐fold increased risk for ischemic stroke . Several case reports and one observational study suggest vitamin K antagonists (VKAs) may improve migraine symptoms . Other anticoagulants have been reported less in the literature, with only one study exploring benefits of heparin in migraine .…”