title: 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.
authors.affiliation: Centro Cefalee Alta Specialità, Dipartimento Area Critica, Reggio Emilia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrarini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Malferrari
authors.forename: Riccardo
authors.initials: R
authors.lastname: Zucco
authors.forename: Oscar
authors.initials: O
authors.lastname: Gaddi
authors.forename: Marcello
authors.initials: M
authors.lastname: Norina
authors.forename: Luigi Alberto
authors.initials: LA
authors.lastname: Pini
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005444:Flunarizine / Q000627:therapeutic use; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D000925:Anticoagulants; D002121:Calcium Channel Blockers; D005444:Flunarizine