Prevalence of Atrial Septal Aneurysm in Patients With Migraine: An Echocardiographic Study

Carerj, Scipione; Narbone, M. C.; Zito, Concetta; Serra, Salvador Manoel; Coglitore, Sebastiano; Pugliatti, Pietro; Luzza, F; Arrigo, F; Oreto, Giuseppe

doi:10.1046/j.1526-4610.2003.03129.x

Cited by 40 publications

(28 citation statements)

References 19 publications

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“…The elevated frequency of PFO among patients with MA has been reported in various studies in recent years [4,20] and interatrial septal aneurysm has also been reported more often [21]. In our study, RLS was found in 61% of the MA patients and 23% of the migraine without aura patients, figures comparable to those published in the literature.…”

Section: Discussionsupporting

confidence: 90%

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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Section: Discussionsupporting

confidence: 90%

Migraine, patent foramen ovale and migraine triggers

Tembl¹,

Lago²,

Sevilla³

et al. 2007

J Headache Pain

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“…ASA and PFO were more common in migraineurs than non-migraineurs in one cohort (OR 2.71; 95% CI 1.36-5.41, p=0.005) [29]. Carerj et al [17] reported that MA+ patients had a higher prevalence of ASA (10 of 35, 28.5%) than migraineurs without aura (2 of 55, 3.6%, p<0.005) or controls (1 of 53, 1.9%, p<0.005). Thirty percent (3 of 10) of the ASA-positive MA+ patients studied by these investigators had coexisting PFO, whereas 100% of migraineurs without aura and control patients with ASA had coexisting PFO [17].…”

Section: Discussionmentioning

confidence: 92%

“…Carerj et al [17] reported that MA+ patients had a higher prevalence of ASA (10 of 35, 28.5%) than migraineurs without aura (2 of 55, 3.6%, p<0.005) or controls (1 of 53, 1.9%, p<0.005). Thirty percent (3 of 10) of the ASA-positive MA+ patients studied by these investigators had coexisting PFO, whereas 100% of migraineurs without aura and control patients with ASA had coexisting PFO [17]. In our patient cohort, there was no relation between large RLS and stroke or TIA.…”

Section: Discussionmentioning

confidence: 98%

“…Characteristics of the interatrial septum in patients with PFO, particularly coexisting atrial septal aneurysm (ASA), have been implicated in increased risk of stroke [14][15][16] and in migraine with aura [17]. In a case-control study using transoesophageal echocardiography (TEE) [18], a PFO measuring >4 mm in diameter was associated with higher risk for stroke or transient ischaemic attack (TIA).…”

Section: Introductionmentioning

confidence: 99%

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Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics

et al. 2007

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The objective of the study was to assess differences in proportion of large right-to-left shunt (RLS) and atrial septal characteristics between migraineurs and non-migraineurs referred for transcatheter closure of patent foramen ovale (PF0). This retrospective study took place in a large metropolitan medical centre. The patients were migraineurs with aura (n=52), migraineurs without aura (n=19) and non-migraineurs (n=149). RLS was evaluated before closure using bilateral power m-mode transcranial Doppler at rest and after calibrated, sustained Valsalva manoeuvre, and graded with a validated 0-5 scale. Intracardiac echocardiography was used to assess atrial septal characteristics. Migraineurs had a higher proportion of large RLS (Grade IV or V) than nonmigraineurs at rest and after calibrated Valsalva (rest, p=0.04; Valsalva, p=0.01). Atrial septal characteristics were similar between groups. Migraine is associated with larger RLS at rest and strain; however migraine status does not predict PFO characteristics.

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“…The presence of PFO or atrial septal aneurysm has been well studied in recurrent cerebrovascular events (MAS) and the association between PFO and transient global amnesia (TGA) suggested that intermittent microemboli in the late vertebrobasilar vessels territory underlie at least some TGA cases. The prevalence of atrial septal aneurysms is significantly higher in patients with MA compared with patients with migraine without aura and with control subjects [21]. In this case, a formation of clots near the aneurysmatic surface which is often riddled with microscopic holes, or paradoxical embolisation through a coexisting PFO, or atrial septal defects, or valve prolapse, or other cardiac abnormalities potentially responsible for embolism could be hypothesised.…”

Section: Discussionmentioning

confidence: 92%

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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Prevalence of Atrial Septal Aneurysm in Patients With Migraine: An Echocardiographic Study

Abstract: Our data suggest a role of atrial septal aneurysm in the genesis of aura in patients with migraine.

Cited by 40 publications

References 19 publications

Migraine, patent foramen ovale and migraine triggers

Migraine, patent foramen ovale and migraine triggers

Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics

High prevalence of patent foramen ovale in migraine with aura

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