A thromboembolic predisposition and the effect of anticoagulants on migraine.
OBJECTIVE
To investigate the presence of thromboembolic risk factors and the effect of low-dose acenocoumarol therapy on migraine in patients who spontaneously reported a reduction of their migraine attacks during previous therapeutic use of anticoagulants.


BACKGROUND
The positive effect of anticoagulants on migraine has been described in case reports and observational studies. It remains unclear whether this concerns only a select group of migraineurs with certain common characteristics.


METHODS
In 4 migraineurs with a self-reported reduction of attack frequency during previous use of anticoagulants (international normalization ratio [INR], 2.5:4.0), the presence of thromboembolic risk factors and the effect of low-dose acenocoumarol therapy (INR, 1.5:2.0) on migraine attacks were prospectively investigated in an open study.


RESULTS
All patients had one or more thromboembolic risk factors. Two patients, both with factor V Leiden heterozygosity, experienced a clear improvement of migraine during low-dose acenocoumarol therapy.


CONCLUSIONS
Our findings support the hypothesis that migraine, as a phenotype, has different underlying mechanisms, amongst which a thromboembolic tendency. In this group of patients, oral anticoagulants may be a suitable form of migraine prophylaxis, but this needs further clinical investigation.
Wammes-van der Heijden
Elisabeth A
EA
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, The Netherlands.
Tijssen
Cees C
CC
van't Hoff
Annelies R
AR
Egberts
Antoine C G
AC
D000074:Acenocoumarol / Q000627:therapeutic use*; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000188:drug therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D000074:Acenocoumarol