Patent foramen ovale, a possible cause of symptomatic migraine: a study of 74 patients with acute ischemic stroke.

Sztajzel, Roman; Genoud, David; Roth, Stefan; Mermillod, Bernadette; Floch-Rohr, J. Le

doi:10.1046/j.1526-4610.2003.03062_16.x

Cited by 58 publications

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“…The passage of more than 3 microemboli in the following three cardiac cycles was considered a diagnosis for PFO. This procedure was repeated a maximum of four times [6].…”

Section: Methodsmentioning

confidence: 99%

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High prevalence of patent foramen ovale in migraine with aura

Ferrarini¹,

Malferrari

Zucco³

et al. 2005

J Headache Pain

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IntroductionThe patent foramen ovale (PFO) is a residue of foetal circulation and is found to be patent in approximately 20%− 30% of the adult population. In these subjects there is an interatrial right-to-left (R-L) shunting when right atrial pressure exceeds the pressure present in the left atrium. The association between PFO and stroke and other neurological diseases has been well documented by both perspective and historical studies [1,2].Transoesophageal sonography represents the gold standard for the diagnosis and follow-up of patients suffering from neurological diseases possibly due to J Headache Pain (2005) 6:71-76 DOI 10.1007 High prevalence of patent foramen ovale in migraine with aura Abstract In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour-coded sonography (c-TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c-TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c-TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.

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“…The passage of more than 3 microemboli in the following three cardiac cycles was considered a diagnosis for PFO. This procedure was repeated a maximum of four times [6].…”

Section: Methodsmentioning

confidence: 99%

“…A high prevalence of MA is reported in patients with paradoxical embolism, suggesting a possible role of this association in the occurrence of cerebrovascular events [6]. Right-to-left shunts are also associated with some forms of decompression illness, suggesting the possibility that these shunts have a role in the aetiology of MA [7].…”

mentioning

confidence: 99%

High prevalence of patent foramen ovale in migraine with aura

Ferrarini¹,

Malferrari

Zucco³

et al. 2005

J Headache Pain

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“…In fact, an association between stroke, PFO and migraine has been reported [5,18,19]. Along with stroke, however, migraine and particularly MA have been the focus of greater interest in studies on PFO.…”

Section: Discussionmentioning

confidence: 99%

Migraine, patent foramen ovale and migraine triggers

Tembl¹,

Lago²,

Sevilla³

et al. 2007

J Headache Pain

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Little information exists about a causal association between PFO and migraine. Some patients identify Valsalva-provoking activities (VPA) as migraine triggers. Therefore, we speculate about a pathogenic connection. The object of the study is to investigate the prevalence of right-to-left shunt (RLS) in a cohort of patients suffering migraine with aura (MA) and its possible association with migraine attacks triggered by VPA. We investigated the circumstances triggering the migraine attacks, in a consecutive series of 72 MA patients and in a series of migraine without aura age and gender-matched. The presence and extent of RLS was assessed by transcranial Doppler. Massive RLS appeared in 38.9% of MA and in 6.5% of migraine without aura ( p <0.001). MA patients identified at least one VPA as headache trigger in 45.8%. A trend was found between these triggering activities and massive RLS, both in MAgroup OR 2.7 [1.02–7.17] and in all migraine patients OR 2.5 [1.01–6.11]. According to our results, patients with migraine who have larger RLS tend to recognize activities that increase the extent of the shunt as a trigger of their migraine attacks.

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“…Nowadays, some studies have reported an inc reased prevalence of PFO in patients with migraine with aura, and closure of PFO was associated with complete disappearance of migraine attacks in some patients 14,15 . Although this is not be the aim of this paper, in our small series, two patients (mother and daughter, 6 and 4 respectively) re p o rted disappearance of aura and reduction of migraine attacks along 28 months of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Patent foramen ovale in a cohort of young patients with cryptogenic ischemic stroke

Silva

Rodrigues

Tress³

et al. 2005

Arq. Neuro-Psiquiatr.

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OBJECTIVE: Although its role is a matter of debate, some studies described a higher prevalence of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in young stroke patients, with higher risk with PFO / ASA association (OR 4.96). The aim of this study was determine the prevalence of PFO and ASA in a cohort of cryptogenic ischemic stroke (IS) patients younger than 55 years and to follow-up after surgical or percutaneous endovascular closure (PEC). METHOD: In 21 months we identified all patients less than 55 years old with IS who were admitted to our hospital. Cryptogenic IS was considered if there is not an identifiably cause to cerebral ischemia. Transesophageal echocardiography (TEE) was performed in all patients. After interatrial septal abnormalities diagnosis, percutaneous device closure was offered to all. Patients were followed monthly and keeped with oral AAS or Clopidogrel. RESULTS: We identified 189 patients with IS and 32 were less than 55 years old (16.9%). In 29 the IS was cryptogenic. TEE was performed in all patients and some form of interatrial septal abnormality was identified in 12 (12/29 - 41.3%); 5 had a PFO and in 7 there was PFO plus ASA. Ten patients were submitted to PEC and 2 were submitted to surgical closure. In mid-term follow-up (28 months) no ischemic events occurred and 2 patients related disappearance of migraine symptoms. CONCLUSION: Our small series description is in accordance with other studies and suggests a possible relation between interatrial septal abnormalities and IS in a cohort of young patient.

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Patent foramen ovale, a possible cause of symptomatic migraine: a study of 74 patients with acute ischemic stroke.

Cited by 58 publications

References 0 publications

High prevalence of patent foramen ovale in migraine with aura

High prevalence of patent foramen ovale in migraine with aura

Migraine, patent foramen ovale and migraine triggers

Patent foramen ovale in a cohort of young patients with cryptogenic ischemic stroke

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