Effectiveness and Safety of Transcatheter Patent Foramen Ovale Closure for Migraine (EASTFORM) Trial

Xing, Yingqi; Guo, Yuzhu; Gao, Yongsheng; Guo, Zhen‐Ni; Niu, Peng-Peng; Yang, Yi

doi:10.1038/srep39081

Cited by 25 publications

(18 citation statements)

References 33 publications

(40 reference statements)

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“…There are clinical trials showing that treatment for right-to-left shunt has not increased responder rate defined as 50% reduction in migraine attacks; however, it has significantly reduced headache days. 11–14 Similarly to the stroke trials, they had initial negative RCTs. With better patient selection and longer follow-up, subsequent trials may show more cessation of migraine headache.…”

Section: Discussionmentioning

confidence: 99%

“… 10 There are clinical trials showing that treatment for right-to-left shunt can significantly reduce headache days although the responder rate defined as a 50% reduction in migraine attacks is not different from baseline. 11–14 In addition, the meta-analyses showed that a complete resolution of migraine after treatment for right-to-left shunt occurred in 54% of migraine-with-aura cases and in 39% of migraine-without-aura cases. 15 16 Therefore, right-to-left shunt may be a fundamental cause of migraine.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China

et al. 2018

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ObjectivesTo investigate the relationship between right-to-left shunt and migraine to account for the unexplained high prevalence of migraine in patients with epilepsy.DesignThis is a cross-sectional study. The diagnosis and interview process of patients with migraine was based on the International Classification of Headache Disorders-3 beta in patients with epilepsy. Participants underwent transthoracic echocardiography (TTE) with contrast medium to identify right-to-left shunt. The highest number of microbubbles were recorded in the left atrium before the complete microbubble outflow of the right atrium. A moderate-to-large shunt was defined as the presence of 10 or more microbubbles.SettingA single-centre, cross-sectional study in China, 2015–2017.ParticipantsPatients with epilepsy.Primary and secondary outcome measuresThe primary outcome measures were the prevalence of migraine, the prevalence of right-to-left shunt in patients with migraine and those without migraine, and the prevalence of migraine in different degrees of shunting.ResultsThree hundred thirty-nine participants with epilepsy who completed TTE were included in the analysis. The overall prevalence of migraine was 23.0%. One-third of the migraineurs had mild right-to-left shunt and one-fifth of the migraineurs had moderate-to-large right-to-left shunt. Patients with mild shunt did not have a higher prevalence of migraine than those without shunt (26.3% vs 18.1%, p=0.102); however, a higher prevalence of migraine was found in patients with moderate-to-large shunt (39.0% vs 18.1%, OR=2.90, 95% CI=1.41 to 5.98, p=0.003). Patients with migraine and patients without migraine had similar prevalence of mild shunt; however, patients with migraine had more moderate-to-large shunt (20.5% vs 9.6%, p=0.002). Right-to-left shunt and female were factors predicting migraine prevalence.ConclusionsOne-fifth of migraineurs were correlated with moderate-to-large right-to-left shunt which could be an underlying cause of migraine in epilepsy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China

et al. 2018

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“… 35 The MIST trial, along with PREMIUM (Prospective, Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects With Migraine and PFO Using the AMPLATZER PFO Occluder to Medical Management) and PRIMA (Percutaneous Closure of PFO in Migraine with Aura) trials showed negative results for PFO closure as migraine treatment. 36 ‘PFO closure did not reduce overall monthly migraine days’. 37 …”

Section: New Development Discussionmentioning

confidence: 99%

Migraine and stroke

2017

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Migraines are generally considered a relatively benign neurological condition. However, research has shown an association between migraines and stroke, and especially between migraine with aura and ischaemic stroke. Patients can also suffer from migrainous infarction, a subset of ischaemic stroke that often occurs in the posterior circulation of younger women. The exact pathogenesis of migrainous infarct is not known, but it is theorised that the duration and local neuronal energy level from cortical spreading depression may be a key factor. Other factors contributing to migrainous infarct may include vascular, inflammatory, endothelial structure, patent foramen ovale, gender, oral contraceptive pill use and smoking. Vasoconstrictors such as the triptan and ergot class are commonly used to treat migraines and may also play a role. Migraine is also shown to be correlated to haemorrhagic stroke, although studies do not demonstrate causation versus association, and further studies are warranted. There are also some rare genetic diseases such as cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy, retinal vasculopathy with cerebral leukodystrophy and others, which can cause both migraines and infarcts. On imaging, many migraineurs are found to have white matter changes similar to those seen in patients with stroke. These may be caused in part by alterations in resting cerebral blood flow and vasoconstrictor use. In treating patients with migraines, it is important to identify and modify any vascular risk factors such as hypertension, smoking, oral contraceptive pill use and lifestyle factors. Further studies will determine if more aggressive treatment of migraines can ultimately lead to fewer strokes in this population.

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“…Based on standards reported by Jauss et al ., Wessler et al ., and Xing et al . [7, 15, 16], a five-level categorization system was used in this study based on the appearance of MBs in the TCD spectrum using unilateral MCA monitoring as follows: Grade 0, negative; Grade I, 1 ≤ MBs ≤ 10; Grade II, 10 < MBs ≤ 25; Grade III, > 25 MBs and no curtain; and Grade IV, curtain where a single bubble cannot be identified (Fig 2). …”

Section: Methodsmentioning

confidence: 99%

Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuver

Wang

et al. 2017

PLoS ONE

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Contrast-enhanced transcranial Doppler (c-TCD) has been used to detect right-to-left shunts (RLS) because it is highly sensitive and cost-effective. The use of provocation maneuvers, such as physiologic maneuvers (e.g., coughing) and the Valsalva maneuver (VM) to transiently increase right atrial pressure and induce RLS increases the sensitivity of RLS detection. In this study, we sought to determine whether coughing is as effective as the VM in aiding the detection of RLS. We evaluated 162 subjects for RLS, using c-TCD under three different conditions: (i) resting state, (ii) coughing, and (iii) modified VM (m-VM), which involved blowing into a tube connected to a sphygmomanometer at 40 mmHg for 10 s. The positive rate of RLS detection with the m-VM was significantly higher than that with coughing. In addition, a difference between the two maneuvers was observed in terms of the degree of RLS seen. The m-VM should be widely used to detect RLS, because it is reliable, standardized, and cost-effective.

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Effectiveness and Safety of Transcatheter Patent Foramen Ovale Closure for Migraine (EASTFORM) Trial

Cited by 25 publications

References 33 publications

Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China

Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China

Migraine and stroke

Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuver

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