Incidence of patent foramen ovale and migraine headache in adults with congenital heart disease with no known cardiac shunts

Abstract

The purpose of this study was to understand why patients with adult congenital heart disease (CHD) but no obvious shunt have an increased frequency of migraine headaches (MH). CHD patients with no known cardiac shunts (CHD-NKS), based on their echocardiographic or angiographic procedures, were tested for a right-to-left shunt using agitated saline contrast transcranial Doppler (TCD). Medical records of 2,920 patients from the UCLA Adult CHD Center were screened to participate in a study to evaluate the prevalence of MH in adults with CHD; 182 patients (6.23%) had CHD-NKS; of these, 60 (30%) underwent a TCD; 23 (38%) tested positive and 37 (62%) tested negative for a right-to-left shunt (P = 0.01 compared with controls). The frequency of MH was 43% in CHD-NKS compared with 11% in controls (P < 0.0001). TCD demonstrated right-to-left shunting in approximately 2/3 of patients with pulmonary stenosis, the Marfan syndrome and congenitally corrected transposition of great vessels, 1/4 of patients with bicuspid aortic valve, 1/5 of patients with mitral valve prolapse and all patients with Ebstein's anomaly. Approximately half of these experienced MH. Patients who had MH did not show a higher frequency of right-to-left shunt when compared with patients without MH (P = 0.57). In conclusion, CHD patients with conditions usually not associated with a shunt have a higher than expected prevalence of PFO which permits intermittent right-to-left shunting undetected by standard non-contrast TTE and TEE; the increased prevalence of right-to-left shunting may partially explain the higher than expected frequency of migraines.

Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions

“…PFO has been associated with cryptogenic stroke, decompression sickness, platypnea-orthodeoxia syndrome, and migraine headache. [131][132][133][134][135][136][137][138] Controversy exists regarding the role of PFO in these syndromes, and currently, the Food and Drug Administration (FDA) has not approved a role for transcatheter procedures to close the PFO in an attempt to decrease the incidence of these problems. Echocardiography has a central role in the evaluation of PFO and monitoring/guidance of PFO closure, similar to its role in ASD closure.…”

Neurological and spinal manifestations of the Ehlers–Danlos syndromes

“…Findings may be suggestive of a stroke. Diagnostic testing should exclude sleep disorders [Kothari et al, ], menstrual cycle dysfunction including menopause [Nappi and Nappi, ; Ripa et al, ], and patent foramen ovale [Volman et al, ].…”

Joint Hypermobility and Headache: The Glue That Binds the Two Together – Part 2

“…A damaged vascular endothelium might lead to endothelial dysfunction or a showering of the cerebral vasculature with atheroemboli, which might trigger attacks of aura in these patients. Second, right‐to‐left shunts are more common on transcranial Doppler in patients with CTDs (eg, Marfan syndrome, mitral valve prolapse), which could precipitate migraine attacks through right to left thromboembolism . These shunts could represent a patent foramen ovale or intrapulmonary arteriovenous malformations.…”