Effect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons

Wilmshurst, Peter; Nightingale, Simon; Walsh, Karen; Morrison, W.L.

doi:10.1016/s0140-6736(00)03160-3

Cited by 375 publications

(307 citation statements)

References 17 publications

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“…It is characterised by migraine with or without aura, stroke episodes and seizures [28,29]. Another condition in which both migraine and stroke might share a common cause is patent foramen ovale (PFO) [30][31][32]. PFO has been associated with cryptogenic stroke episodes caused by paradoxical embolism through the PFO.…”

Section: Migraine and Cerebral Ischaemia Sharing A Common Causementioning

confidence: 99%

Comorbid neuropathologies in migraine

et al. 2006

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The identification of comorbid disorders in migraineurs is important since it may impose therapeutic challenges and limit treatment options. Moreover, the study of comorbidity might lead to improve our knowledge about causes and consequences of migraine. Comorbid neuropathologies in migraine may involve mood disorders (depression, mania, anxiety, panic attacks), epilepsy, essential tremor, stroke, and white matter abnormalities. Particularly, a complex bidirectional relation exists between migraine and stroke, including migraine as a risk factor for cerebral ischemia, migraine caused by cerebral ischemia, migraine as a cause of stroke, migraine mimicking cerebral ischemia, migraine and cerebral ischemia sharing a common cause, and migraine associated with subclinical vascular brain lesions.

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Section: Migraine and Cerebral Ischaemia Sharing A Common Causementioning

confidence: 99%

Comorbid neuropathologies in migraine

et al. 2006

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“…9 Subsequently, 2 recent studies reported a 2-to 5-fold increased prevalence for migraine in PFO carriers. 10,11 The reason for this apparent association between PFO and migraine remains undefined.…”

Section: Migrainementioning

confidence: 99%

Contemporary Management of Patent Foramen Ovale

2003

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“…In 2000, Wilmshurst et al reported relief of migraines in patients undergoing PFO closure for cryptogenic stroke or deep sea decompression illness. PFO closure symptomatically improved or completely relieved migraines with and without aura in 18/21 subjects [37]. Subsequently, over 11 observational reports with 1632 subjects have corroborated these findings [ Table 2] [23], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47] and [48].…”

Section: Pfo and Migrainesmentioning

confidence: 69%

Patent foramen ovale: Unanswered questions

Mojadidi

Christia

Salamon

et al. 2015

European Journal of Internal Medicine

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The foramen ovale is a remnant of the fetal circulation that remains patent in 20-25% of the adult population. Although long overlooked as a potential pathway that could produce pathologic conditions, the presence of a patent foramen ovale (PFO) has been associated with a higher than expected frequency in a variety of clinical syndromes including cryptogenic stroke, migraines, sleep apnea, platypnea-orthodeoxia, deep sea diving associated decompression illness, and high altitude pulmonary edema. A unifying hypothesis is that a chemical or particulate matter from the venous circulation crosses the PFO conduit between the right and left atria to produce a variety of clinical syndromes. Although observational studies suggest a therapeutic benefit of PFO closure compared to medical therapy alone in patients with cryptogenic stroke, 3 randomized controlled trials (RCTs) did not confirm the superiority of PFO closure for the secondary prevention of stroke. However, meta-analyses of these RCTs demonstrate a significant benefit of PFO closure over medical therapy alone. Similarly, observational studies provide support for PFO closure for symptomatic relief of migraines. But one controversial randomized study failed to replicate the results of the observational studies while another two demonstrated a partial benefit. The goal of this review is to discuss the clinical conditions associated with PFO and provide internists and primary care physicians with current data on PFO trials, and clinical insight to help guide their patients who are found to have a PFO on echocardiographic testing. Embryology and anatomySince fetal lungs in utero are incapable of oxygenating blood, the fetus is dependent on the maternal circulation for oxygen delivery via the placenta. Oxygenated blood returning to the right atrium via the umbilical vein needs to be delivered to the brain and vital organs before further loss of oxygen occurs. To facilitate this rapid transit, an inter-atrial communication evolved in all mammals, known as the foramen ovale [1].After birth, the foramen ovale flap (the septum primum) physiologically closes against the septum secundum when pulmonary vascular resistance and right atrial pressure decrease. An atrial septal aneurysm (ASA), a saccular deformity of the atrial septum that protrudes 15 mm in the direction of either atria, is associated with 15% of PFOs and is often seen with the largest size PFO [3] and [4]. PFO imagingThe most accurate test for determining the presence of a PFO is a right heart catheterization with documentation of a guidewire crossing the atrial septum. The standard non-invasive method for diagnosing a PFO is transesophageal echocardiography (TEE) using agitated saline contrast [5]. Transcranial Doppler (TCD) is a more sensitive and less uncomfortable method for diagnosing PFO with a sensitivity of 97% and specificity of 93% [6]. Transthoracic echocardiogram (TTE) with bubble study is a less expensive, non-invasive test compared to TEE with comparable specificity [7] and [8]. Howeve...

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Effect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons

Cited by 375 publications

References 17 publications

Comorbid neuropathologies in migraine

Comorbid neuropathologies in migraine

Contemporary Management of Patent Foramen Ovale

Patent foramen ovale: Unanswered questions

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