High prevalence of patent foramen ovale in migraine with aura

Abstract

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.

Small deep white matter lesions are associated with right-to-left shunts in migraineurs

“…The results presented here indicate that the small dWMLs were the lesions specific for migraine and were associated with RLS. In addition, RLS was related to aura, as described in a previous study [12]. The prevalence of medium or large dWMLs was not higher in migraineurs than in patients with TTH, and the existence of RLS was not related to the frequent occurrence of these sized dWMLs (data was not shown).…”

Neuroradiology and headaches

“…Also the presence of arteriovenous (AV) shunts, such as patent foramen ovale (PFO), can represent a trigger for migraine with aura attacks. A higher prevalence of PFO was demonstrated in migraineurs vs. the normal population [18].…”

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.…”