Mitral valve prolapse and abnormalities of haemostasis in children and adolescents with migraine with aura and other idiopathic headaches: a pilot study.
OBJECTIVE
To investigate the prevalence of mitral valve prolapse (MVP) and abnormalities of haemostasis in children and adolescents with migraine with aura (MA) compared with peers affected by other idiopathic headaches.


METHODS
We recruited 20 MA patients (10 men and 10 women; age range 8-17 years) and 20 sex- and age-matched subjects with other idiopathic headaches. Both groups underwent colour Doppler transthoracic echocardiography to detect MVP and the following laboratory work-up: plasma prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen, protein C, protein S, homocysteine, lupus anticoagulant, von Willebrand factor (vWF) ristocetin cofactor activity, immunoglobulins (Ig) G and M anticardiolipin antibodies (aCL). Factor V Leiden, factor II and methylenetetrahydrofolate reductase were investigated (we did not test the entire genes, but screened for specific point mutations).


RESULTS
The prevalence of MVP was significantly higher in the MA subjects than in the patients affected by other idiopathic headaches (40% vs 10%; P < 0.05). Moreover, the MA patients showed a higher rate of above-normal IgM aCL titres (45% vs 10%; P < 0.05). Finally, in the group of patients with MVP we found a higher prevalence of aCL in those with MA compared with those affected by other idiopathic headaches.


CONCLUSIONS
A proportion, at least, of the MA patients showed a more complex phenotype characterized by MVP and/or positive aCL titres. The pathogenetic role of these associations is obscure and larger studies are needed to confirm the usefulness of echocardiographic and laboratory investigations in this area and to identify possible new treatment approaches that might be explored in this group of MA patients.
Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences, University of Insubria, Piazza Biroldi 19, Varese, Italy. cristiano.termine@uninsubria.it
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C
Termine
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Trotti
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P
Ondei
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Gamba
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Montani
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A
Gamba
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M
De Simone
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E
Marni
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Balottin
D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000453:epidemiology* / Q000235:genetics; D001780:Blood Coagulation Tests; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D006580:Genetic Carrier Screening; D006720:Homozygote; D006801:Humans; D015994:Incidence; D008297:Male; D020325:Migraine with Aura / Q000453:epidemiology* / Q000235:genetics; D008945:Mitral Valve Prolapse / Q000453:epidemiology* / Q000235:genetics; D018781:Tension-Type Headache / Q000453:epidemiology