An unusual case report on the possible role of Warfarin in migraine prophylaxis

Russo, Angelo; Santi, Sara; Gueraldi, Daniela; Paola, Maria De; Zani, Fabiana; Pini, Luigi Alberto

doi:10.1186/2193-1801-2-48

Cited by 10 publications

(23 citation statements)

References 10 publications

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“…Because the exact pathophysiology is not clear, the microthrombi hypothesis is still one of the many hypotheses for the cause of MA. Although no studies actually prove the microthrombi hypothesis, several case reports have been published showing benefit of warfarin in patients suffering MA . As mentioned before, we did not find a significant association between PFO without ASA and MA in our study.…”

Section: Discussioncontrasting

confidence: 59%

Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study

Snijder

Luermans

Heij

et al. 2016

JAHA

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BackgroundA patent foramen ovale (PFO) with atrial septal aneurysm (ASA) has been identified as a risk factor for cryptogenic stroke. Patients with migraine with aura (MA) appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between MA and PFO with ASA has never been reported. We examined this association in a large observational study.Methods and ResultsPatients (>18 years) who underwent an agitated saline transesophageal echocardiography (cTEE) at our outpatient clinics within a timeframe of 4 years were eligible to be included. Before cTEE they received a validated headache questionnaire. Two neurologists diagnosed migraine with or without aura according to the International Headache Criteria. A total of 889 patients (mean age 56.4±14.3 years, 41.7% women) were included. A PFO was present in 23.2%, an isolated ASA in 2.7%, and a PFO with ASA in 6.9%. The occurrence of migraine was 18.9%; the occurrence of MA was 8.1%. The prevalence of PFO with ASA was significantly higher in patients with MA compared to patients without migraine (18.1% vs 6.1%; OR 3.72, 95% CI 1.86‐7.44, P<0.001). However, a PFO without ASA was not significantly associated with MA (OR 1.50, 95% CI 0.79‐2.82, P=0.21). Interestingly, a PFO with ASA was strongly associated with MA (OR 2.71, 95% CI 1.23‐5.95, P=0.01).ConclusionIn this large observational study, PFO with ASA was significantly associated with MA only. PFO closure studies should focus on this specific intra‐atrial anomaly.

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Section: Discussioncontrasting

confidence: 59%

Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study

Snijder

Luermans

Heij

et al. 2016

JAHA

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“…These observations are consistent with other case reports associating warfarin with reduced migraine symptoms . In these cases, migraines were either abolished completely or greatly reduced in frequency and intensity with VKA therapy.…”

Section: Discussionsupporting

confidence: 93%

“…We are limited in that our case did not have thrombophilia screening performed, thus we are unable to rule out the contribution of inherited hypercoagulable states in this specific case. Evidence for the contribution of a genetic component in symptomatic migraine improvement among VKA‐responsive patients has been mixed, with one study identifying a hypercoagulable genetic polymorphism in 4/4 patients responding to VKAs, while three other cases had normal findings …”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Migraines are associated with hypercoagulable states, with an estimated 1.2‐ to 2.2‐fold increased risk for ischemic stroke . Several case reports and one observational study suggest vitamin K antagonists (VKAs) may improve migraine symptoms . Other anticoagulants have been reported less in the literature, with only one study exploring benefits of heparin in migraine .…”

Section: Introductionmentioning

confidence: 99%

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A Case of Migraine With Aura Resolving on Warfarin But Not on Apixaban

Nilsson

Bungard

2017

Headache

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Several case reports have associated anticoagulants such as heparin and vitamin K antagonists with reduced symptoms in migraine, but no data exist for direct acting oral factor Xa inhibitors. We report the case of a 55-year-old female who experienced complete remission of migraine with aura for 12 years while on warfarin, with return of symptoms within 3 weeks of switching to apixaban, and resolution of symptoms once again within days of warfarin resumption. Our case suggests that anticoagulation alone is not sufficient to improve migraine symptoms. Further study of vitamin K-dependent proteins not involved in anticoagulation, such as the relatively novel growth arrest-specific gene 6, may clarify the link between warfarin and migraine symptoms.

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“…MO and other unspecified non-migrainous headaches have been considered in one study [3], while an improvement in MO, migraine with aura, hemiplegic migraine and chronic cluster headache has been sporadically documented [2,[5][6][7]. However, warfarin seems to be principally effective in reducing the frequency of migraine rather of other primary headaches [2,3].…”

Section: Discussionmentioning

confidence: 94%