Migraine, patent foramen ovale and migraine triggers

Abstract

Little information exists about a causal association between PFO and migraine. Some patients identify Valsalva-provoking activities (VPA) as migraine triggers. Therefore, we speculate about a pathogenic connection. The object of the study is to investigate the prevalence of right-to-left shunt (RLS) in a cohort of patients suffering migraine with aura (MA) and its possible association with migraine attacks triggered by VPA. We investigated the circumstances triggering the migraine attacks, in a consecutive series of 72 MA patients and in a series of migraine without aura age and gender-matched. The presence and extent of RLS was assessed by transcranial Doppler. Massive RLS appeared in 38.9% of MA and in 6.5% of migraine without aura ( p <0.001). MA patients identified at least one VPA as headache trigger in 45.8%. A trend was found between these triggering activities and massive RLS, both in MAgroup OR 2.7 [1.02–7.17] and in all migraine patients OR 2.5 [1.01–6.11]. According to our results, patients with migraine who have larger RLS tend to recognize activities that increase the extent of the shunt as a trigger of their migraine attacks.

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

“…The balloon diameter at PFO closure corresponded to the degree of RLS in this study; however, no correlation coefficient was reported [6]. In one study, migraineurs with aura were more likely to have headache triggers associated with Valsalva-provoking activities and have larger RLS than migraineurs without aura [30]. Spontaneous large RLS and MA+ were both risk factors for recurrent stroke in patients with PFO (large RLS OR 2.42, 95% CI 1.66-5.04; MA+ OR 3.87, 95% CI 1.75-8.50) [31].…”

Latin American consensus on guidelines for chronic migraine treatment

“…There is no data in the literature showing the association between cardiovascular diseases and chronic migraine. First papers suggest the association between migraine and patent foramen ovale 27 , but this has not been confirmed in subsequent studies 28 . There are no specific papers on the association of patent foramen ovale and chronic migraine.…”

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.…”