Impact of right-to-left shunt and transcatheter closure on the clinical features of migraine

He, Qiu; Zhang, Yingbin; Wang, Fengzhi; Li, Chao; Guo, Rong; Li, Xiangnan; Liu, Bo; Zhao, Hongwei; Meng, Lili; Chen, Hui‐Sheng; Meng, Lei

doi:10.1080/00207454.2019.1672681

Cited by 14 publications

(13 citation statements)

References 30 publications

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“…Likewise, Garg et al () also found no association between the degree of RLS and clinical features of migraine headaches. However, He et al () reported that the headache frequency, migraine disability assessment score, and headache impact test‐6 score were significantly higher in patients with RLS than those without RLS. The degree of shunt does not appear to be related to the clinical parameters of headache, suggesting that the mechanism of the association between RLS and migraine is not only related to the degree of shunt, but also to the shear stress.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of right‐to‐left shunt in the different subgroups of migraine

et al. 2020

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Objective Several investigations have documented an association between migraine and right‐to‐left shunt (RLS). However, whether there are specific clinical features that can distinguish between migraine patients with and without RLS is unclear. This study aims to explore whether there are specific clinical features that can distinguish between migraine patients with and without RLS, and to investigate the relationship between the degree of shunt and clinical parameters of headache. Methods In this study, we enrolled consecutive migraineurs who underwent a structured, standardized questionnaire for family and personal history and for detailed migraine features. RLS was diagnosed based on a contrast enhancement transcranial Doppler (c‐TCD) examination. Results Overall, 113 migraine with aura (MA) and 192 migraine without aura (MO) patients were included. Patients with MA and RLS (MARLS+) had a higher frequency for sensory aura symptoms than those with MA without RLS (MARLS−) (27.4% vs. 10.0%, p = .03). Patients with MO and RLS (MORLS+) presented with significantly younger initial age of migraine onset and experienced more severe pain intensity than those with MO without RLS (MORLS−) (mean ± SD, 25.6 ± 8.9 vs. 29.8 ± 12.7 years, p = .008 and 5.9 ± 1.4 vs. 5.3 ± 1.3, p = .006, respectively). There was no relationship between the degree of shunt and the clinical parameters of headache. Conclusions Our results indicate that MO patients presented with a younger initial age of migraine onset and that sensory aura symptoms in MA patients may predict the presence of RLS. However, we did not find support for relationship between the degree of shunt and clinical parameters of headache.

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Section: Discussionmentioning

confidence: 99%

Clinical features of right‐to‐left shunt in the different subgroups of migraine

et al. 2020

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“…Migraine with aura after PFO closure in the first few weeks is terminated if the patient is prescribed clopidogrel 75 mg/d for the first 4 weeks after the closure procedure (37). A previous study revealed that MIDAS scores among the migraine patients with moderate or large PFO-RLS were notably higher than those in patients from the mild PFO-RLS group and non-RLS group (P < 0.05) (38).…”

Section: Discussionmentioning

confidence: 99%

A Nomogram for the Prediction of Cessation of Migraine Among Patients With Patent Foramen Ovale After Percutaneous Closure

2020

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Objective: This study aimed to develop and validate a nomogram to predict cessation of patent foramen ovale (PFO) patients with migraine headache after percutaneous closure. Methods: A total of 247 eligible patients with PFO and migraine after percutaneous closure between May, 2016 and May, 2018 were divided into a development cohort (n = 149) and a validation cohort (n = 98). The primary end point was cessation of migraine at follow-up of 1 year after the procedure measured by the Migraine Disability Assessment Score (MIDAS). In the development cohort, the LASSO regression was used data dimension reduction. A multivariable logistic regression analysis was used to develop the predicting nomogram. The performance of the nomogram was assessed by concordance index (C-index), calibration and clinical usefulness. The results were validated in the validation cohort. Results: Migraine with aura, history of antiplatelet, and the right-to-left shunt (RLS) at rest were identified as significant predictors based on the analysis of multivariate logistic regression. The nomogram incorporating these variables showed good calibration and discrimination in the development cohort with C-index of 0.906 (95% CI: 0.847-0.965), which was confirmed using the validation cohort with C-index of 0.827 (95% CI: 0.751-0.903). The nomogram showed good agreement between prediction by nomogram and actual observation. Furthermore, the decision curve indicated that the novel nomogram was clinically useful. Conclusion: The novel nomogram showed favorable predictive accuracy for cessation of migraine among patients with PFO after percutaneous closure and might provide constructive guidance in clinical decision making.

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“…In the case control studies, PFO closure is also associated with decreased migraine severity ( 32 , 86 – 90 ) (see Table 2 ). In a study, PFO closure had statistically significant benefit with VAS, HIT-6 and MIDAS scores and the headache duration ( 39 ), especially for patients younger than 45 years ( 91 ). In addition, the closure of PFO resulted in a significant reduction in the use of abortive medications ( 86 ).…”

Section: The Relationship Between Patent Foramen Ovale and Migrainementioning

confidence: 99%

“…Recently, it was found that the attack frequency, HIT-6, and MIDAS scores among migraine patients with moderate or large PFO were significantly higher than those of the mild PFO and non-PFO groups. After PFO closure, the differences in VAS, HIT-6 and MIDAS scores as well as the headache duration were statistically significant ( 39 ). At this point in time, it cannot be concluded that the scale scores changed due to the attack frequency or severity, but the result does provide more evidence supporting the relationship between PFO presence and migraine presentation.…”

Section: The Relationship Between Migraine and Patent Foramen Ovalementioning

confidence: 99%

The Correlation Between Migraine and Patent Foramen Ovale

Liu

Wang

et al. 2020

Front. Neurol.

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Background: Migraine is a widespread neurological disorder. The patent foramen ovale (PFO) is a remnant of the fetal circulation. Multiple studies suggest that migraine is more prevalent in subjects with PFO and vice versa. It is unclear if there is a causal relationship or simply a co-existence of these two conditions. Furthermore, the treatment of migraine with percutaneous closure PFO remains controversial.Methods: We reviewed studies pertaining to the relationship between PFO and migraine as well as the effects of treatments on migraine attacks.Results: We briefly summarized potential pathophysiological mechanisms of migraine, and elaborated on migraine type, frequency, and clinical symptoms of migraine with PFO and the clinical features of PFO with migraine. We also addressed the effects of PFO closure on migraine attacks.Conclusion: The evidence supports a “dose-response” relationship between migraine and PFO although more work needs to be done in terms of patient selection as well as the inclusion of an antiplatelet control group for PFO closure interventions to uncover possible beneficial results in clinical trials.

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Impact of right-to-left shunt and transcatheter closure on the clinical features of migraine

Cited by 14 publications

References 30 publications

Clinical features of right‐to‐left shunt in the different subgroups of migraine

Clinical features of right‐to‐left shunt in the different subgroups of migraine

A Nomogram for the Prediction of Cessation of Migraine Among Patients With Patent Foramen Ovale After Percutaneous Closure

The Correlation Between Migraine and Patent Foramen Ovale

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