Migraine, patent foramen ovale and migraine triggers.
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 MA group 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.
Tembl
Jose
J
Neurology Service, Universitary Hospital, La Fe, Avda Campanar 21, E-46009, Valencia, Spain. tembl-jos@gva.es
Lago
Aida
A
Sevilla
Teresa
T
Solis
Pilar
P
Vilchez
Juan
J
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods; D014636:Valsalva Maneuver