Frequency and clinical implications of hypercoagulability states in a cohort of patients with migraine with aura

Cecchi, Gianluca; Paolucci, Matteo; Ulivi, Martina; Assenza, Federica; Brunelli, Nicoletta; Rizzo, Angelo Cascio; Altamura, Claudia; Vernieri, Fabrizio

doi:10.1007/s10072-018-3353-y

Cited by 3 publications

(2 citation statements)

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“…70 Patent foramen ovale (PFO) is an independent risk factor for migraine with aura. 71 A meta-analysis of trials examining the effects of PFO closure in migraineurs concluded that the procedure may be beneficial in patients whose predominant migraine type includes aura. 72 However, a subsequent randomized controlled trial of 230 patients failed to reach the primary end point of a 50% reduction of migraine attacks after PFO closure.…”

Section: Managing the Comorbidities Of Migraine With Auramentioning

confidence: 99%

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

et al. 2019

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Recent insights into the clinical presentation and pathophysiology of migraine aura have paved the way for new treatments for this common but frequently debilitating condition. Marked efflux of cellular potassium and glutamate contributes to the cortical spreading depression that forms the electrophysiological basis of migraine aura phenomena. Secondary vascular perturbations also contribute to the various symptoms of a migraine attack. Calcitonin gene-related peptide (CGRP) plays a key role in many of these steps, and a growing class of CGRP-antagonists have emerged as a novel, efficacious preventative therapy. It is still not fully understood why a preponderance of migraine aura symptoms is visual, and this issue is an active area of research. In addition, the pathophysiological changes responsible for visual snow syndrome are under investigation. Before diagnosing a patient with migraine aura, it is important to consider the differential diagnosis of transient visual phenomena, with attention to clinical features that may suggest conditions such as retinal disorders, transient ischemic attack, or occipital epilepsy.

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Section: Managing the Comorbidities Of Migraine With Auramentioning

confidence: 99%

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

et al. 2019

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“…Platelet activation could explain the increased vascular risk in migraine patients [ 18 , 19 ], supporting the evidence that antiplatelet therapy can relieve MA [ 20 ] also in patients without right-to-left shunt (RLS) [ 21 ]. It is not clear whether thrombophilia can be observed in migraine patients: some studies report an increased prevalence of prothrombotic polymorphisms [ 22 , 23 ], but no univocal results are available [ 24 ]. A transient hypoperfusion caused by the pro-thrombotic and pro-inflammatory states has been hypothesized as the origin of migraine attack [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Hemodynamics, Right-to-Left Shunt and White Matter Hyperintensities in Patients with Migraine with Aura, Young Stroke Patients and Controls

Brunelli

Altamura

Mallio

et al. 2022

IJERPH

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Background: Migraine with aura (MA) patients present an increased risk of cerebrovascular events. However, whether these patients present an increased white matter hyperintensities (WMHs) load compared to the general population is still under debate. Our study aimed to evaluate the relationship between cerebral hemodynamics, right-to-left shunt (RLS) and WMHs in MA patients, young patients with cryptogenic stroke or motor transient ischemic attack (TIA) and controls. Methods: We enrolled 30 MA patients, 20 young (<60 years) patients with cryptogenic stroke/motor TIA, and 10 controls. All the subjects underwent a transcranial Doppler bubble test to detect RLS and cerebral hemodynamics assessed by the breath holding index (BHI) for the middle (MCA) and posterior (PCA) cerebral arteries. Vascular risk factors were collected. The WMHs load on FLAIR MRI sequences was quantitatively assessed. Results: The stroke/TIA patients presented a higher prevalence of RLS (100%) compared with the other groups (p < 0.001). The MA patients presented a higher BHI compared with the other groups in the PCA (p = 0.010) and higher RLS prevalence (60%) than controls (30%) (p < 0.001). The WMHs load did not differ across groups. BHI and RLS were not correlated to the WMHs load in the groups. Conclusions: A preserved or more reactive cerebral hemodynamics and the presence of a RLS are likely not involved in the genesis of WMHs in MA patients. A higher BHI may counteract the risk related to their higher prevalence of RLS. These results need to be confirmed by further studies to be able to effectively identify the protective role of cerebral hemodynamics in the increased RLS frequency in MA patients.

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Pathophysiological Bases of Comorbidity in Migraine

Altamura

Corbelli

Tommaso

et al. 2021

Front. Hum. Neurosci.

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Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.

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Frequency and clinical implications of hypercoagulability states in a cohort of patients with migraine with aura

Cited by 3 publications

References 3 publications

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

Cerebral Hemodynamics, Right-to-Left Shunt and White Matter Hyperintensities in Patients with Migraine with Aura, Young Stroke Patients and Controls

Pathophysiological Bases of Comorbidity in Migraine

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