Prevalence of Patent Foramen Ovale in Migraine Patients with and Without Aura Compared with Stroke Patients. A Transcranial Doppler Study

Abstract

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7% in migraine with aura (MA) patients, 33.7% in migraine without aura (MoA) patients, 33.8% in young stroke patients and 20.5% in elderly stroke patients (P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1% and 25% (P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

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

“…In a previous study, migraineurs with and without aura had larger degrees of RLS measured by single-gated TCD than non-migraineurs [20]; however, the authors found no difference between migraine groups. Carod-Artal et al [5] reported that MA+ had a higher incidence of PFO than migraineurs without aura (MA-) (52% vs. 34%, p=0.02), but, in contrast to our findings, found no difference in the degree of RLS between the two groups of migraineurs (shower or curtain pattern: MA+, 77%; MA-, 64%, p=0.55). Wilmshurst et al [6] reported that a significantly higher proportion of MA+ with stroke had clinically relevant RLS as assessed by transthoracic echocardiography than MA+ without stroke and historical normal controls (>6 microbubbles; 84%, 38% and 12%, respectively).…”

“…Across all age groups, migraineurs are more likely to experience ischaemic stroke than non-migraineurs (relative risk [RR] 2.16, 95% confidence interval [CI] 1.89-2.48), especially migraineurs who have aura (RR 2.88, 95% CI 1.89-4.39) [3]. Epidemiological data indicate an increased incidence of patent foramen ovale (PFO) with intermittent right-to-left interatrial shunting (RLS) in migraineurs and cryptogenic ischaemic stroke patients compared to the general population [4][5][6]. The incidence of RLS in migraineurs in one study was 41%, relative to 16% in healthy controls [4].…”

The relationship between migraine and right-to-left shunt in children

“…Control group 12/8 11.5 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) patients with RLS tend to report Valsalva-provoking activities to trigger their headache attacks [30]. We also consider the Valsalva maneuver may suggest that opening of RLS acted as a trigger for migraine attack.…”

“…Even if such cardiac anomalies are not detected, migraine itself is a significant factor for stroke [7]. Some studies on adults have shown relatively higher frequency of RLS in patients with migraine, especially migraine patients with aura [1,9].…”

Percutaneous closure of the patent foramen ovale: A cardiological perspective

“…(29,35,(48)(49)(50) and major complications (tamponade, infection, thrombus formation) in less than 1.5% of cases respectively. (10,41,42,53,54) Late erosions into surrounding tissues have been described with all intracardiac devices, but are rare after PFO closure. Residual shunts are common immediately following implantation, but infrequent (5-10%) after 12 months.…”