A retrospective review of clopidogrel as primary therapy for migraineurs with right to left shunt lesions.
BACKGROUND
The association of patient foramen ovale (PFO) and migraine headache (migraine) with aura (MA) is well established. Current research suggests a mechanistic link between platelet activation, paradoxical embolization and migraine in some patients.


METHODS
Clopidogrel, a platelet inhibitor, was added to existing migraine therapy, as a 4-week open-label trial in 15 women, aged 16-56 years, with severe migraine and documented right to left shunt (RLS).


RESULTS
13/15 had > 50% reduction or complete elimination of migraine symptoms. After completing the trial period, five responders remain on clopidogrel with ongoing benefit at 11.9 ± 4.5 months (6.5-20), one stopped clopidogrel because of side effects. Nine other responders underwent PFO closure and clopidogrel discontinuation. Eight of nine have had ongoing benefit.


CONCLUSIONS
Clopidogrel may have a primary prophylactic role in migraine/RLS patients, but may also help select candidates who would benefit from PFO closure. A randomized clinical trial is being established.
Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center, New York-Presbyterian Hospital, Center for Interventional Cardiovascular Therapy, NY, USA.
Barbara T
BT
Spencer
Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center, New York-Presbyterian Hospital, Center for Interventional Cardiovascular Therapy, NY, USA.
Yasir
Y
Qureshi
Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center, New York-Presbyterian Hospital, Center for Interventional Cardiovascular Therapy, NY, USA rs2463@columbia.edu.
Robert J
RJ
Sommer
D000293:Adolescent; D000328:Adult; D000077144:Clopidogrel; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D020325:Migraine with Aura / Q000150:complications* / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
Clopidogrel; migraine headache; patent foramen ovale