Aspirin Prophylaxis for Migraine with Aura: An Observational Case Series

Turk, Wendy E; Uiterwijk, Anouk; Pasmans, Raphaël; Meys, Vera; Ayata, Cenk; Koehler, Peter J.

doi:10.1159/000481252

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…Moreover, sham (ie, non‐SD) groups are exposed to the same anesthesia protocol. Last, in the chronic model, we repeated SD induction every other day for 2 weeks, to mirror the frequency of attacks in patients experiencing more than 2 attacks per month 24 . The impact of less frequent but protracted SD exposure on pain behavior remains to be tested.…”

Section: Discussionmentioning

confidence: 99%

“…Sham animals for the single (n = 31) and repeated (n = 28) SD groups were handled in a similar fashion as SD animals, they underwent glass coverslip placement and had similar exposures to isoflurane anesthesia and handling. In the repeated SD group, we induced SD every other day to model a high attack frequency based on the previously reported average of 12 aura attacks per month (range 2–60) in patients experiencing > 2 attacks per month 24 …”

Section: Methodsmentioning

confidence: 99%

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Optogenetic Spreading Depression Elicits Trigeminal Pain and Anxiety Behavior

Harriott

Chung

Uner

et al. 2020

Annals of Neurology

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Objective Cortical spreading depression (SD) is an intense depolarization underlying migraine aura. Despite the weight of evidence linking SD to the pain phase of migraine, controversy remains over a causal role of SD in cephalgia because of the invasive nature of previous SD induction methods. To overcome this problem, we used a novel minimally invasive optogenetic SD induction method and examined the effect of SD on behavior. Methods Optogenetic SD was induced as a single event or repeatedly every other day for 2 weeks. End points, including periorbital and hindpaw mechanical allodynia, mouse grimace, anxiety, and working memory, were examined in male and female mice. Results A single SD produced bilateral periorbital mechanical allodynia that developed within 1 hour and resolved within 2 days. Sumatriptan prevented periorbital allodynia when administered immediately after SD. Repeated SDs also produced bilateral periorbital allodynia that lasted 4 days and resolved within 2 weeks after the last SD. In contrast, the hindpaw withdrawal thresholds did not change after repeated SDs suggesting that SD‐induced allodynia was limited to the trigeminal region. Moreover, repeated SDs increased mouse grimace scores 2 days after the last SD, whereas a single SD did not. Repeated SDs also increased thigmotaxis scores as a measure of anxiety. In contrast, neither single nor repeated SDs affected visuospatial working memory. We did not detect sexual dimorphism in any end point. Interpretation Altogether, these data show a clinically congruent causal relationship among SD, trigeminal pain, and anxiety behavior, possibly reflecting SD modulation of hypothalamic, thalamic, and limbic mechanisms. ANN NEUROL 2021;89:99–110

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Optogenetic Spreading Depression Elicits Trigeminal Pain and Anxiety Behavior

Harriott

Chung

Uner

et al. 2020

Annals of Neurology

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“…15 Although evidence for a link between migraine and cardiovascular disease exist, it is still unclear whether migraine itself increases the risk or is a marker of another underlying cause. Improvement of aura with aspirin 37 and migraine with warfarin 38 has been observed in observational case studies; however, further research is necessary to confirm these effects. There is no evidence that controlling migraine attacks with preventive drugs can reduce cardiovascular risk.…”

Section: Migraine and Risk Of Cardiovascular Diseasementioning

confidence: 98%

Migraine and risk of stroke

Øie

Kurth

Gulati

et al. 2020

J Neurol Neurosurg Psychiatry

148

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Migraine and stroke are two common and heterogeneous neurovascular disorders responsible for a significant burden for those affected and a great economic cost for the society. There is growing evidence that migraine increases the overall risk of cerebrovascular diseases. In this review, based on available literature through a PubMed search, we found that ischaemic stroke in people with migraine is strongly associated with migraine with aura, young age, female sex, use of oral contraceptives and smoking habits. The risk of transient ischaemic attack also seems to be increased in people with migraine, although this issue has not been extensively investigated. Although migraine appears to be associated with haemorrhagic stroke, the migraine aura status has a small influence on this relationship. Neuroimaging studies have revealed a higher prevalence of asymptomatic structural brain lesions in people with migraine. They are also more likely to have unfavourable vascular risk factors; however, the increased risk of stroke seems to be more apparent among people with migraine without traditional risk factors. The mechanism behind the migraine-stroke association is unknown. In light of the higher risk of stroke in people with migraine with aura, it is important to identify and modify any vascular risk factor. There is currently no direct evidence to support that a migraine prophylactic treatment can reduce future stroke in people with migraine.

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“…Although not recommended for migraine prophylaxis in current headache guidelines, 173 antiplatelet medications (aspirin and thienopyridines, clopidogrel, and ticagrelor) have been studied in persons with migraine, including in those with PFO or who are status post closure procedures (Table 3). 174‐181 Given the paucity of randomized controlled trials (RCT) and the inconsistency of results, additional research, especially in persons with MWA and PFO, is indicated. The 3 RCT of percutaneous PFO closure in persons with migraine (MIST, 182 PRIMA, 183 and PREMIUM 184 ) failed to meet their primary endpoints, which differed between the trials (Table 4).…”

Section: Mechanistic Implications Of Clinical Trialsmentioning

confidence: 99%

Migraine and Ischemic Stroke in Women. A Narrative Review

Tietjen

Maly

2020

Headache

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Objective/Background.-Migraine is associated with ischemic stroke. Women are 3-fold as likely as men to have migraine, and high estrogen states increase the risk of migraine with aura (MWA), venous thromboembolism (VTE), and of stroke. We review the epidemiological and mechanistic evidence of the migraine-stroke relationship and its risk factors, with a focus on women and conditions that exclusively or predominantly affect them.Methods.-We performed a search of MEDLINE/PubMed database, then a narrative review of the epidemiological evidence of the migraine-stroke relationship as well as the evidence for arterial, thrombophilic, and cardiac mechanisms to explain this connection. We examine the implications of this evidence for the diagnostic evaluation and treatment of MWA.Results.-MWA is associated with multiple stroke risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, atrial fibrillation, and patent foramen ovale. In women, MWA is also associated with biomarkers of endothelial activation, hormonal contraceptive use, pregnancy, and VTE. This suggests that a subset of auras may be secondary, that is, induced by ischemia related to microemboli or in situ thrombosis. MWA-associated ischemic stroke is more common in young (<45 years old) women with high frequency of migraine attacks, hormonal contraception use, and with pregnancy and preeclampsia. There is increasing evidence that cardioembolism, often in conjunction with thrombophilia, plays a prominent role in MWA-associated cerebral infarction.Conclusion.-The commonality of factors associated with MWA and with MWA-associated stroke suggest that persons with secondary, ischemia-induced aura may be at elevated risk of stroke. Although further research is needed, we recommend consideration of a diagnostic evaluation of MWA that mirrors the evaluation of transient ischemic attack, given that prophylactic treatment targeting the ischemic origin of secondary aura may prevent migraine as well as stroke.

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Aspirin Prophylaxis for Migraine with Aura: An Observational Case Series

Cited by 18 publications

References 14 publications

Optogenetic Spreading Depression Elicits Trigeminal Pain and Anxiety Behavior

Optogenetic Spreading Depression Elicits Trigeminal Pain and Anxiety Behavior

Migraine and risk of stroke

Migraine and Ischemic Stroke in Women. A Narrative Review

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