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Lu W, Dai H, Li Y, Meng X. Neurological and cardiopulmonary manifestations of pulmonary arteriovenous malformations. Front Med (Lausanne) 2024; 11:1449496. [PMID: 39364022 PMCID: PMC11446853 DOI: 10.3389/fmed.2024.1449496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 09/06/2024] [Indexed: 10/05/2024] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) are direct pulmonary artery-to-vein connections without pulmonary capillaries that result in intrapulmonary right-to-left blood shunts. Although most patients with PAVMs may be entirely asymptomatic, PAVMs can induce a series of complications involving the neurological, cardiovascular, and respiratory systems that can lead to catastrophic and often fatal clinical sequelae. In this study we review the available literature and summarize the reported PAVM-related complications among patients with PAVMs. The reviewed studies included observational studies, case studies, prospective studies, and cohort studies, and we provide an overview of PAVM-related neurological and cardiopulmonary manifestations, including stroke, cerebral abscess, transient ischemic attack, cerebral hemorrhage, migraine, seizure, dizziness, cardiac failure, arrhythmia, myocardial infarction, cough, hypoxemia, dyspnea, respiratory failure, hemoptysis, and hemothorax. Identifying and treating PAVMs before the presentation of major complication is important because this can prevent the occurrence of complications and can result in better outcomes. PAVM patients should thus be better evaluated and managed by a multidisciplinary team because they may be in a treatable phase prior to their condition becoming life-threatening.
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Affiliation(s)
- Weida Lu
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Honggang Dai
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Yunyi Li
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Xiao Meng
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
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Cao W, Jiao L, Zhou H, Zhong J, Wang N, Yang J. Right-to-left shunt-associated brain functional changes in migraine: evidences from a resting-state FMRI study. Front Hum Neurosci 2024; 18:1432525. [PMID: 39281370 PMCID: PMC11392749 DOI: 10.3389/fnhum.2024.1432525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/21/2024] [Indexed: 09/18/2024] Open
Abstract
Background Migraine, a neurological condition perpetually under investigation, remains shrouded in mystery regarding its underlying causes. While a potential link to Right-to-Left Shunt (RLS) has been postulated, the exact nature of this association remains elusive, necessitating further exploration. Methods The amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo) and functional connectivity (FC) were employed to investigate functional segregation and functional integration across distinct brain regions. Graph theory-based network analysis was utilized to assess functional networks in migraine patients with RLS. Pearson correlation analysis further explored the relationship between RLS severity and various functional metrics. Results Compared with migraine patients without RLS, patients with RLS exhibited a significant increase in the ALFF within left middle occipital and superior occipital gyrus; In migraine patients with RLS, significantly reduced brain functional connectivity was found, including the connectivity between default mode network and visual network, ventral attention network, as well as the intra-functional connectivity of somatomotor network and its connection with the limbic network, and also the connectivity between the left rolandic operculum and the right middle cingulate gyrus. Notably, a significantly enhanced functional connectivity between the frontoparietal network and the ventral attention network was found in migraine with RLS; Patients with RLS displayed higher values of the normalized clustering coefficient and greater betweenness centrality in specific regions, including the left precuneus, right insula, and right inferior temporal gyrus. Additionally, these patients displayed a diminished nodal degree in the occipital lobe and reduced nodal efficiency within the fusiform gyrus; Further, the study found positive correlations between ALFF in the temporal lobes, thalamus, left middle occipital, and superior occipital gyrus and RLS severity. Conversely, negative correlations emerged between ALFF in the right inferior frontal gyrus, middle frontal gyrus, and insula and RLS grading. Finally, the study identified a positive correlation between angular gyrus betweenness centrality and RLS severity. Conclusion RLS-associated brain functional alterations in migraine consisted of local brain regions, connectivity, and networks involved in pain conduction and regulation did exist in migraine with RLS.
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Affiliation(s)
- Wenfei Cao
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Jiao
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huizhong Zhou
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Zhong
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nizhuan Wang
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Jiajun Yang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Voudris KV, Poulin MF, Kavinsky CJ. Updates on Patent Foramen Ovale (PFO) Closure. Curr Cardiol Rep 2024; 26:735-746. [PMID: 38913234 DOI: 10.1007/s11886-024-02073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW Patent foramen ovale (PFO) has been previously linked to left circulation thromboembolism and stroke. This review article aims to discuss the latest evidence, updated societal guidelines, diagnostic algorithms and novel therapeutic devices for PFO closure. RECENT FINDINGS PFO closure for cryptogenic stroke and systemic embolization is supported by a large body of evidence and has a strong societal recommendation. Limited data are available for platypnea-orthodeoxia syndrome, although closure appears to be beneficial. Current data do not support routine closure for migraines and decompression Illness. Development of heart-brain teams can improve identification of patients most likely to benefit from closure, utilizing a combination of imaging test and risk score algorithms. Multiple novel devices aiming at reducing complications and improving the long-term impact of current available devices are being evaluated. PFO closure has significantly progressed over the last years, with new data supporting its superiority in reducing risk of recurrent embolic stroke in patients with PFO-related stroke. Additional clinical data are required to provide further refinements on patient selection and guidance on treatment of specific subgroups.
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Affiliation(s)
- Konstantinos V Voudris
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Marie-France Poulin
- Department of Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Street, Baker 4, Boston, MA, 02215, USA
| | - Clifford J Kavinsky
- Department of Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Street, Baker 4, Boston, MA, 02215, USA.
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Li Z, Dong J, Yan Y, Fang F, Wang C, Zhang F, Ouyang W, Wang S, Pan X. Study design and rationale of COMPETE: Comparison of the effect of medication therapy in alleviating migraine with patent foramen ovale. Am Heart J 2024; 269:1-7. [PMID: 38109984 DOI: 10.1016/j.ahj.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Previous studies have examined the impact of antithrombotic agents on Patent Foramen Ovale (PFO) in relation to migraine. However, differences in effectiveness of different antithrombotic agents and traditional migraine medications are not known. METHODS/DESIGN This study is an investigator-initiated, randomized, multicenter, single-masked (outcomes assessor), and active-controlled parallel-group trial (ClinicalTrials.gov Identifier: NCT05546320), with the objective of evaluating the prevention efficacy of antithrombotic agents compared to first-line migraine medication in PFO patients. The trial involves 1,000 migraine patients with a right-to-left shunt at the atrial level, randomized in a 1:1:1:1 fashion to receive either aspirin 300 mg QD, clopidogrel 75 mg QD, rivaroxaban 20 mg QD, or the active-control metoprolol 25 mg BID. The primary efficacy end point is the response rate, defined as a 50% or greater reduction in the average migraine attack days per month or in the average number of migraine attacks per month at 12-week visit compared to baseline. CONCLUSIONS The COMPETE trial aims to provide valuable insights into the comparative effectiveness of antithrombotic agents and standard migraine therapies in patients with PFO. This study holds the promise of advancing treatment approaches for individuals having migraines associated with PFO, thus addressing an important gap in current migraine management strategies.
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Affiliation(s)
- Ziping Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Dong
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yiming Yan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fang Fang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chuangshi Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenbin Ouyang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shouzheng Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Evola S, Camarda EA, Triolo OF, Adorno D, D’Agostino A, Novo G, Onorato EM. Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience. J Clin Med 2023; 12:5788. [PMID: 37762729 PMCID: PMC10531865 DOI: 10.3390/jcm12185788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess clinical outcomes and quality of life after PFO closure in patients with previous stroke/TIA of undetermined cause and in patients with other complex PFO-associated clinical conditions. METHODS Between July 2009 and December 2019 at our University Cardiology Department, 118 consecutive patients underwent a thorough diagnostic work-up including standardized history taking, clinical evaluation, full neurological examination, screening for thrombophilia, brain magnetic resonance imaging (MRI), ultrasound-Doppler sonography of supra-aortic vessels and 24 h ECG Holter monitoring. Anatomo-morphological evaluation using 2D transthoracic/transesophageal echocardiography (TTE/TEE) color Doppler and functional assessment using contrast TTE (cTTE) in the apical four-chamber view and contrast transcranial Doppler (cTCD) using power M-mode modality were performed to verify the presence, location and amount of right-to-left shunting via PFO or other extracardiac source. Completed questionnaires based on the Quality-of-Life Short Form-36 (QoL SF-36) and Migraine Disability Assessment (MIDAS) were obtained from the patients before PFO closure and after 12 months. Contrast TTE/TEE and cTCD were performed at dismission, 1, 6 and 12 months and yearly thereafter. Brain MRI was performed at 1-year follow-up in 54 patients. RESULTS Transcatheter PFO closure was performed in 106 selected symptomatic patients (mean age 41.7 ± 10.7 years, range 16-63, 65% women) with the following conditions: ischemic stroke (n = 23), transient ischemic attack (n = 22), peripheral and coronary embolism (n = 2), MRI lesions without cerebrovascular clinical events (n = 53), platypnea-orthodeoxia (n = 1), decompression sickness (n = 1) and refractory migraine without ischemic cerebral lesions (n = 4). The implanted devices were Occlutech Figulla Flex I/II PFO (n = 99), Occlutech UNI (n = 3), Amplatzer PFO (n = 3) and CeraFlex PFO occluders (n = 1). Procedures were performed under local anesthesia and rotational intracardiac monitoring (Ultra ICE) alone. The devices were correctly implanted in all patients. The mean fluoroscopy time was 15 ± 5 min (range = 10-45 min) and the mean procedural time was 55 ± 20 min (range = 35-90 min). The total occlusion rate at follow-up (mean 50 months, range 3-100) was 98.1%. No recurrent neurological events were observed in the long-term follow-up. CONCLUSIONS The data collected in this study demonstrate that percutaneous PFO closure is a safe and effective procedure, showing long-term prevention of recurrent cerebrovascular events, significant reduction in migraine symptoms and substantial improvement in quality of life.
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Affiliation(s)
- Salvatore Evola
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Emmanuele Antonio Camarda
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Oreste Fabio Triolo
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Daniele Adorno
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Alessandro D’Agostino
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Giuseppina Novo
- Department Promise, Università di Palermo, UOC Cardiologia, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy;
| | - Eustaquio Maria Onorato
- University Cardiology Department, Galeazzi-Sant’Ambrogio Hospital, Scientific Institute for Research, Hospitalization and Healthcare (I.R.C.C.S.), Via Cristina Belgioioso 173, 20157 Milan, Italy
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Shuming J, Hua L, Yusha T, Lei C. The efficacy and safety of patent Foramen Ovale Closure for Refractory Epilepsy (PFOC-RE): a prospectively randomized control trial of an innovative surgical therapy for refractory epilepsy patients with PFO of high-grade right-to-left shunt. BMC Neurol 2023; 23:282. [PMID: 37501155 PMCID: PMC10373383 DOI: 10.1186/s12883-023-03317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND A significant proportion of patients with epilepsy have an unknown etiology and lack effective targeted therapeutic drugs. Patent Foramen Ovale (PFO) induces hypoxia and microembolism, leading to cerebral neurological dysfunction and increased epilepsy risk. This study aims to assess the efficacy and safety of PFO closure for relieving epileptic seizures in patients with refractory epilepsy associated with PFO. METHODS/DESIGN Recruitment takes place at the West China Hospital of Sichuan University, China, for an open-label, randomized controlled clinical trial. The trial will include 110 patients with refractory epilepsy and PFO. Disease diagnoses will conform to the diagnostic criteria of the International League Against Epilepsy (ILAE) for refractory epilepsy and the American Society of Echocardiography (ASE) for PFO. Refractory epilepsy and high-grade right-to-left shunt (RLS) of the PFO will be further diagnosed using 24-hour video electroencephalogram and transthoracic echocardiography with contrast injection, respectively. Eligible participants require a secondary or higher volume of RLS. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2200065681). Registered on November 11, 2022.
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Affiliation(s)
- Ji Shuming
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, 610044, China
| | - Li Hua
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, 610044, China
| | - Tang Yusha
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, 610044, China
| | - Chen Lei
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, 610044, China.
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Kim JH, Lee Y, Kwon YS, Sohn JH. Clinical Implications of the Association between Respiratory and Gastrointestinal Disorders in Migraine and Non-Migraine Headache Patients. J Clin Med 2023; 12:jcm12103434. [PMID: 37240541 DOI: 10.3390/jcm12103434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Headaches, particularly migraine, are associated with gastrointestinal (GI) disorders. In addition to the gut-brain axis, the lung-brain axis is suspected to be involved in the relationship between pulmonary microbes and brain disorders. Therefore, we investigated possible associations of migraine and non-migraine headaches (nMH) with respiratory and GI disorders using the clinical data warehouse over 11 years. We compared data regarding GI and respiratory disorders, including asthma, bronchitis, and COPD, among patients with migraine, patients with nMH, and controls. In total, 22,444 patients with migraine, 117,956 patients with nMH, and 289,785 controls were identified. After adjustment for covariates and propensity score matching, the odds ratios (ORs) for asthma (1.35), gastroesophageal reflux disorder (1.55), gastritis (1.90), functional GI disorder (1.35), and irritable bowel syndrome (1.76) were significantly higher in patients with migraine than in controls (p = 0.000). The ORs for asthma (1.16) and bronchitis (1.33) were also significantly higher in patients with nMH than in controls (p = 0.0002). When the migraine group was compared with the nMH group, only the OR for GI disorders was statistically significant. Our findings suggest that migraine and nMH are associated with increased risks of GI and respiratory disorders.
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Affiliation(s)
- Jong-Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea
| | - Yeonkyeong Lee
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea
| | - Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea
| | - Jong-Hee Sohn
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
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Lee S, Yeo J, Lee SH, Lee YJ, Lee S, Ha IH. Trends in healthcare utilisation of patients with migraine in South Korea: a retrospective observational study using Health Insurance Review and Assessment Service National Patient Sample data from 2010 to 2018. BMJ Open 2023; 13:e059926. [PMID: 36944456 PMCID: PMC10032417 DOI: 10.1136/bmjopen-2021-059926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE This study used 2010-2018 Health Insurance Review and Assessment Service National Patient Sample data to analyse the distribution and healthcare utilisation of patients with migraine in South Korea. DESIGN Retrospective, observational study using serial cross-sectional data. PARTICIPANTS Patients with primary diagnosis of G43, a Korean Standard Classification of Diseases-10 code for migraine, were included in the analysis. The exclusion criteria were missing code information; code for dental, health centre or psychiatry; institution type specified as nursing hospital, psychiatric hospital, dental hospital, midwifery centre or health centre; blank entries for total cost or days of care. 453 246 records of patients and 117 157 patients corresponding to those records were identified. OUTCOME MEASURES Primary outcome measures were medical service utilisation status, treatment methods and drug use status associated with migraine. RESULTS Cases and patients of migraine increased from 48 846 and 19 468 (2010) to 52 729 and 20 802 (2018), respectively, increases of 7.95% and 6.85%, respectively, compared with 2010. Total cost of care increased from $921 857.88 (2010) to $1 711 219.60 (2018). The most common age range of patients was 45-54 years, with 2.69 times more female than male patients. In Western medicine hospitals, subcutaneous or intramuscular injection therapy was used frequently, while in Korean medicine hospitals, acupuncture therapy was used. Among Western medicine outpatients, more than 50% of the therapeutics prescribed for acute migraine were simple analgesics or non-steroidal anti-inflammatory drugs. The number of prescriptions for the prevention of episodic migraine increased from 13 600 cases (2010) to 20 546 cases (2018), representing the steepest increase in drug utilisation. CONCLUSIONS Treatments frequently used in Western and Korean medicine hospitals and their frequency of use and costs were identified. The findings of this study can be used as a basis for relevant health policy decisions.
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Affiliation(s)
- Sookyung Lee
- Department of Korean Rehabilitation Medicine, Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Jiyoon Yeo
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
- Department of Economics, Korea University, Seoul, Republic of Korea
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Sangkwan Lee
- Department of Internal Medicine and Neuroscience, Wonkwang University Hospital, Iksan, Republic of Korea
- Department of Internal Medicine, Wonkwang University Gwangju Korean Medicine Hospital, Gwangju, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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Onorato EM, Salvia J, Becchina M, Cipolla T, Anzola GP. Can aura migraine be elicited by isolated pulmonary arteriovenous fistula?-A case report. Front Neurol 2022; 13:1079959. [PMID: 36588875 PMCID: PMC9797860 DOI: 10.3389/fneur.2022.1079959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
A pulmonary arteriovenous fistula (PAVM) is an abnormal blood vessel that creates a direct connection between a pulmonary artery and its tributary vein bypassing capillary filter, establishing as a consequence of a low-resistance right-to-left shunting (RLS). The vast majority of PAVMs are congenital appearing more often in females than in males. A great number of patients with PAVMs is suffering concurrently from hereditary hemorrhagic telangiectasia (HHT) whose incidence is around 1 in 5,000. Very few cases of acquired PAVMs have been described in the literature. Paradoxical embolism through PAVMs can cause systemic desaturation, cyanosis, and serious cerebrovascular ischemic events (transient ischemic attacks, strokes, and intracranial abscess), even when the abnormal blood vessel is small (diameter <3 mm). Notably, it has been reported a high prevalence of aura migraine (MHA) symptoms in patients with PAVMs and concomitant HHT. We described in this study the case of a young aura migraineur female patient without HHT in whom isolated PAVM below the detection limit of pulmonary angiography and chest computed tomography angiography (CTA) has been documented by contrast Transthoracic and Transesophageal Echocardiography (cTTE/TEE) showing a delayed (>17 s) RLS coming from left pulmonary veins to left atrium while a patent foramen ovale (PFO), small atrial septal defects or septum primum fenestration could not be detected despite several attempts. Contrast Transcranial Doppler (cTCD) confirmed a delayed (>16 s) RLS with two short "shower" patterns corroborating the diagnosis of an extra-cardiac RLS. During the right heart catheterization and pulmonary angiography, it was impossible to cross the interatrial septum with a multipurpose catheter. The patient was finally discharged with off-label thienopyridine agents (clopidogrel 75 mg die) in terms of primary prophylaxis for paradoxical right-to-left embolization of thrombotic material ultimately. Aura migraine symptoms were nearly abolished by P2Y12 platelet inhibition, suggesting a platelet-based mechanism. During 2 years of clinical follow-up on thienopyridine therapy, the resolution of aura migraine episodes was definitively accomplished with significant improvement in her quality of life.
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Affiliation(s)
- Eustaquio Maria Onorato
- R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio GSD, Milan, Italy,*Correspondence: Eustaquio Maria Onorato
| | - Josephal Salvia
- Cardiology Department, Istituto Fondazione G. Giglio di Cefalù, Palermo, Italy
| | - Mariano Becchina
- Cardiology Department, Istituto Fondazione G. Giglio di Cefalù, Palermo, Italy
| | - Tommaso Cipolla
- Cardiology Department, Istituto Fondazione G. Giglio di Cefalù, Palermo, Italy
| | - Gian Paolo Anzola
- Neurology Clinic and Rehabilitation Department, Casa di Cura Villa Barbarano, Brescia, Italy
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Yeo JYP, Goh CXY, Tan YK, Sim BTS, Chan BLX, Syn NL, Lim Y, Chan ACY, Sharma VK, Ong JJY, Yeo LLL, Sia CH, Tan BYQ. Evaluating the relationship between right-to-left shunt and white matter hyperintensities in migraine patients: A systematic review and meta-analysis. Front Neurol 2022; 13:972336. [PMID: 36061988 PMCID: PMC9433673 DOI: 10.3389/fneur.2022.972336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction White matter hyperintensities (WMHs) have been observed with greater frequency in patients with migraine and are thought to be associated with impaired cognition and function. The relationship between WMHs and right-to-left shunt (RLS) in migraine patients is unknown. We performed a systematic review to determine if there is an association between RLS and WMHs in patients with migraine. Methods A systematic search of the literature was performed in PubMed and Embase using a suitable keyword search strategy from inception up to 16th June 2021. All studies that included patients with migraine and studied RLS and WMHs were included. Results A total of 8 non-randomized observational studies comprising 1125 patients with migraine were included; 576 had an RLS, compared to 549 patients with no RLS. The mean age of the study populations ranged from 28.4 to 43 years, while the average duration from migraine diagnosis ranged from 5.1 to 19 years. The proportion of female to male patients was consistently higher in all studies (60.0–94.4%). Amongst migraine patients with RLS, 338 patients (58.7%) had WMHs. In contrast, 256 (46.6%) of migraine patients without RLS had WMHs. RLS was significantly associated with the presence of WMHs in migraine patients (OR: 1.56, 95% CI: 1.05–2.34, p = 0.03). Conclusion In migraine patients, RLS was significantly associated with the presence of WMHs. Longitudinal studies are warranted to establish RLS as a risk factor for WMHs in patients with migraine, and to establish the significance of these changes.
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Affiliation(s)
- Joshua Y. P. Yeo
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Claire X. Y. Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Kiat Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bryan T. S. Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Beverly L. X. Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas L. Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yinghao Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Amanda C. Y. Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Vijay K. Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jonathan J. Y. Ong
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Leonard L. L. Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Ching-Hui Sia
| | - Benjamin Y. Q. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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The Patent Foramen Ovale and Migraine: Associated Mechanisms and Perspectives from MRI Evidence. Brain Sci 2022; 12:brainsci12070941. [PMID: 35884747 PMCID: PMC9313384 DOI: 10.3390/brainsci12070941] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
Migraine is a common neurological disease with a still-unclear etiology and pathogenesis. Patent foramen ovale (PFO) is a kind of congenital heart disease that leads to a right-to-left shunt (RLS). Although previous studies have shown that PFO has an effect on migraine, a clear conclusion about the link between PFO and migraine is lacking. We first summarized the PFO potential mechanisms associated with migraine, including microembolus-triggered cortical spreading depression (CSD), the vasoactive substance hypothesis, impaired cerebral autoregulation (CA), and a common genetic basis. Further, we analyzed the changes in brain structure and function in migraine patients and migraine patients with PFO. We found that in migraine patients with PFO, the presence of PFO may affect the structure of the cerebral cortex and the integrity of white matter, which is mainly locked in subcortical, deep white matter, and posterior circulation, and may lead to changes in brain function, such as cerebellum and colliculus, which are involved in the processing and transmission of pain. In summary, this paper provides neuroimaging evidence and new insights into the correlation between PFO and migraine, which will help to clarify the etiology and pathogenesis of migraine, and aid in the diagnosis and treatment of migraine in the future.
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Wang YL, Wang FZ, Zhang Y, Jiang J, Jia Z, Liu X, Wang J, Xu J. Association of migraine with patent foramen ovale closure: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2022; 39:100992. [PMID: 35330668 PMCID: PMC8938194 DOI: 10.1016/j.ijcha.2022.100992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/30/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
Background Method Result Conclusion
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Affiliation(s)
- Yan-Li Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang-Ze Wang
- Department of Cardiology, Weifang People's Hospital, Weifang Medical University, Weifang, China
| | - Yuan Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiwei Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziyan Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiangrong Liu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Wang
- Department of Cardiology, Weifang People's Hospital, Weifang Medical University, Weifang, China
- Corresponding authors at: Department of Cardiology, Weifang People's Hospital, Weifang Medical University, No. 151 Guangwen Street, Kuiwen District, Weifang, China (J. Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 South 4th Ring West Road, Beijing, PR China (J. Xu).
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Corresponding authors at: Department of Cardiology, Weifang People's Hospital, Weifang Medical University, No. 151 Guangwen Street, Kuiwen District, Weifang, China (J. Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 South 4th Ring West Road, Beijing, PR China (J. Xu).
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The Value of Contrast-Enhanced Transesophageal Echocardiography in the Detection of Cardiac Right-to-Left Shunt Related with Cryptogenic Stroke and Migraine. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8845652. [PMID: 33415164 PMCID: PMC7752281 DOI: 10.1155/2020/8845652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/26/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
Abstract
Purpose To analyze the characteristics of right-to-left shunt (RLS) in patients with cryptogenic stroke and migraine by contrast-enhanced transesophageal echocardiography (c-TEE). Methods The study population consisted of 330 patients with cryptogenic stroke and 330 patients with migraine who suspected PFO. All of them received c-TEE examination successfully. In terms of c-TEE analyses, RLS could be diagnosed when microbubbles were visualized in the transition from the right atrium to the left atrium. For semiquantitative analysis, a small amount of RLS was grade 1, indicating 1-10 microvesicles per frame could be seen in the left atrium, a moderate amount of RLS was grade 2, indicating 11-30 microvesicles per frame could be seen in the left atrium, and a large amount of RLS was grade 3, indicating more than 30 microvesicles per frame, or the left atrium is filled with microvesicles. Results A total of 660 patients were analyzed in the study. PFO-RLS was detected in 348 (348/660, 52.7%) cases by TEE, while in 392 (392/660, 59.3%) cases by c-TEE. Simultaneously, P-RLS was detected in 239 (239/660, 36.2%) cases by c-TEE. Among 330 patients with cryptogenic stroke, PFO-RLS was detected in 198 cases; according to the c-TTE method (198/330, 60.0%), concurrently, 83 participants suffered from PFO-RLS and P-RSL (83/330, 25.1%), including 1 case with PFO and pulmonary arteriovenous fistula. Among 330 patients with migraine, PFO-RLS was detected in 194 cases; according to the c-TTE method (194/330, 58.7%), specifically, 90 participants suffered from PFO-RLS and P-RSL (90/330, 27.2%). There was no statistical significance between the two groups. P-RLS singly was detected in 28 cases with cryptogenic stroke, while in 38 cases with migraine, excluding from pulmonary arteriovenous fistula by CTA examination. In addition, semiquantitative results on c-TTE grading of RLS were compared between the two groups: grade 1 RLS in the migraine group (144/322) was significantly higher than that in the cryptogenic stroke group (71/309) (P < 0.05). Grade 3 RLS in the cryptogenic stroke group (113/309) was significantly higher than that in the migraine group (67/322) (P < 0.05). For grade 2 RLS, there was no statistical difference between the two groups (P = 0.12). Conclusions c-TEE can increase the positive rate of PFO diagnosis compared with TEE color Doppler. There is no significant difference in the incidence of PFO-PLS and P-RLS between the cryptogenic stroke group and the migraine group. The grades 2-3 RLS are mainly detected in the cryptogenic stroke group, while grades 1-2 RLS are mostly detected in the migraine group.
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14
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Alakbarzade V, Keteepe-Arachi T, Karsan N, Ray R, Pereira AC. Patent foramen ovale. Pract Neurol 2020; 20:225-233. [DOI: 10.1136/practneurol-2019-002450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 11/03/2022]
Abstract
Patent foramen ovale (PFO) is the most common anatomical cause of an interatrial shunt. It is usually asymptomatic but may cause paradoxical embolism, manifesting as stroke, myocardial infarction or visceral/peripheral ischaemia. PFO is a risk factor for stroke and may be associated with migraine with aura. New evidence suggests PFO closure reduces the risk of recurrent ischaemic stroke in a highly selected population of stroke survivors: those aged 60 years or younger with a cryptogenic stroke syndrome, a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation. They benefit from percutaneous PFO closure in addition to antiplatelet therapy, rather than antiplatelet therapy alone. Current evidence does not support PFO closure in the treatment of migraine.
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15
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He YD, Yan XL, Qin C, Zhang P, Guo ZN, Yang Y. Transcatheter Patent Foramen Ovale Closure Is Effective in Alleviating Migraine in a 5-Year Follow-Up. Front Neurol 2019; 10:1224. [PMID: 31803135 PMCID: PMC6877730 DOI: 10.3389/fneur.2019.01224] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/04/2019] [Indexed: 01/03/2023] Open
Abstract
Background: The association between patent foramen ovale (PFO) and migraine has been reported. However, whether transcatheter PFO closure is effective in alleviating migraine remains controversial. The objective of this study was to investigate the efficacy of PFO closure in alleviating migraine in a 5-year follow-up. Methods: Migraineurs with PFO from 2013 to 2015 were included and divided into PFO closure group and non-PFO closure group according to their therapy. Contrast-enhanced transcranial Doppler (c-TCD) was performed to evaluate the degree of the right-to-left shunt (RLS), and headache impact test (HIT-6) questionnaire was administered to assess the disability of migraine at 1- and 5-year follow-up. Results: Of 192 patients, 91 patients underwent PFO closure, and 101 patients refused. The HIT-6 scores of patients in the PFO closure group were significantly lower than those of the non-PFO closure group at both 1- and 5-year follow-up. These results were more pronounced in patients younger than 45 years. Furthermore, in patients with large RLS, the HIT-6 scores of patients in the PFO closure group were significantly lower at both 1- and 5-year follow-up compared with those of the non-PFO closure group. However, in patients with moderate RLS, this difference was significant only at 5-year follow-up. Conclusions: PFO closure is effective in alleviating migraine in the long term. This effect is more obvious when patients are younger than 45 years and RLS is large.
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Affiliation(s)
- Yao-De He
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xiu-Li Yan
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Chen Qin
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Peng Zhang
- Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
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16
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He Q, Zhang Y, Wang F, Li C, Guo R, Li X, Luan B, Zhao H, Meng L, Chen H, Meng L. Impact of right-to-left shunt and transcatheter closure on the clinical features of migraine. Int J Neurosci 2019; 130:270-275. [PMID: 31549584 DOI: 10.1080/00207454.2019.1672681] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: In this study, we aimed to explore the influence of right-to-left shunt (RLS) presence on the clinical features of migraine and to follow-up on the post-operative curative effect of transcatheter patent foramen ovale (PFO) closure on migraine features.Methods: A total of 103 migraine patients were divided into a mild volume RLS group, moderate volume RLS group, large volume RLS group and non-RLS group in accordance with contrast enhancement transcranial Doppler (c-TCD) findings. The Visual Analogue Scale (VAS) score, migraine frequency, migraine duration, migraine disability assessment (MIDAS) and headache impact test-6 (HIT-6) scores were compared amongst the different groups. A total of 39 patients with moderate or large RLS received transcatheter PFO closure and those patients were followed up by the same criteria.Results: The attack frequency, HIT-6 and MIDAS scores amongst the migraine patients with moderate or large RLS were significantly higher than those in patients from the mild RLS group and non-RLS group (p < .05). The transcatheter closure was successful in all patients (n = 39), and no post-operative complications were observed during the hospitalisation and follow-up period. The differences in VAS, HIT-6 and MIDAS scores as well as the headache duration were statistically significant amongst patients before and after PFO closure (p < .05).Conclusions: Moderate to large RLS significantly influenced the clinical features of migraine, and transcatheter PFO closure could significantly relieve headache symptoms in migraine patients with PFO.
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Affiliation(s)
- Qiu He
- Department of Neurology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Yingbin Zhang
- Nerve Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Fengzhi Wang
- Department of Neurology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Chao Li
- Department of Neurology, The People's Hospital of China, Three Gorges University, YiChang, China
| | - Rong Guo
- Department of Neurology Function, The People's Hospital of Liaoning Province, Shenyang, China
| | - Xiangnan Li
- Department of Neurology Function, The People's Hospital of Liaoning Province, Shenyang, China
| | - Bo Luan
- Department of Cardiovascular Medicine, The People's Hospital of Liaoning Province, Shenyang, China
| | - Hongwei Zhao
- Department of Cardiovascular Medicine, The People's Hospital of Liaoning Province, Shenyang, China
| | - Lili Meng
- Department of Congenital Heart Disease, The General Hospital of Shenyang Military Region, Shenyang, China
| | - Huisheng Chen
- Department of Neurology, The General Hospital of Shenyang Military Region, Shenyang, China
| | - Li Meng
- Graduate School of Dalian Medical University, Dalian, China
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Kato Y, Hayashi T, Kato R, Takao M. Migraine-like Headache after Transseptal Puncture for Catheter Ablation: A Case Report and Review of the Literature. Intern Med 2019; 58:2393-2395. [PMID: 30996181 PMCID: PMC6746642 DOI: 10.2169/internalmedicine.2519-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Catheter ablation for atrial fibrillation creates an iatrogenic atrial septal defect by transseptal puncture, which may produce a transient right-to-left shunt. We encountered a 44-year-old man who presented with de novo migraine-like headache after cryoballoon ablation for atrial fibrillation. On reviewing the literature, we found additional cases in which migraine-like headache occurred within one week after the procedure and spontaneously within three months. We should recognize migraine-like headache as a potential complication of catheter ablation.
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Affiliation(s)
- Yuji Kato
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
| | - Takeshi Hayashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Japan
| | - Masaki Takao
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
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Vaidya K, Khandkar C, Celermajer D. Current management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale. Cardiovasc Diagn Ther 2019; 8:739-753. [PMID: 30740321 DOI: 10.21037/cdt.2018.09.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A patent foramen ovale (PFO) is a remnant interatrial communication, best diagnosed with transoesophageal echocardiography (TOE) and bubble study. Although quite common and often asymptomatic, PFO is associated with cryptogenic stroke and migraine. Approximately one-half of patients with a cryptogenic stroke have a PFO, and the dilemma regarding whether or not to proceed with percutaneous device closure, to reduce the risk of future recurrent events due to paradoxical embolism, has been subject to debate for nearly two decades. Despite promising observational data, initial randomised clinical trials failed to demonstrate superiority of closure over medical therapy. However, long-term follow-up data from one of these early trials, combined with two new randomised trials, have provided more evidence for the benefits of closure in selected patients. This new evidence suggests that younger patients with high-risk features such as an atrial septal aneurysm (ASA) or large interatrial shunt are more likely to benefit from PFO closure, after fastidious exclusion of an alternative cause for the index stroke. However, issues which require further clarification include whether anticoagulant therapy is preferable to antiplatelet therapy for medical management, and which particular type of closure device is optimal. Finally, despite promising retrospective observational data suggesting improvement in migraine attacks after PFO closure, high quality evidence is lacking in this regard.
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Affiliation(s)
- Kaivan Vaidya
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Chinmay Khandkar
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - David Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
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Liu Y, Li S, Wang R, Han X, Su M, Cao X, Wang G, Cao F, Yu S. A New Perspective of Migraine Symptoms in Patients With Congenital Heart Defect. Headache 2018; 58:1601-1611. [PMID: 30444273 DOI: 10.1111/head.13453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the association between congenital heart defects (CHDs) and migraine and evaluate the efficacy of transcatheter defect closure from a new perspective. METHODS The patients with CHDs who underwent transcatheter defect closure were screened in the medical database of Chinese PLA General Hospital from January 2006 to January 2017. The assessment included basic admission information, the 3-item ID Migraine Screener, and a detailed questionnaire administered by telephone or in an outpatient clinic. Patients were divided into ventricular septal defect (VSD) group and AP group (ie, patients with ASD or PFO) based on the type of defects. The latter group could be further divided into right-to-left shunt (RLS) group and left-to-right (LRS) shunt group. Each group contained 4 subgroups according to their migraine diagnosis before and after defect closure: persistent migraine (PM), relieved migraine (RM), without migraine (WM), and new-onset migraine (NM). RESULTS The study recruited total 441 CHDs patients. Most patients in RLS group had migraine before and/or after surgery (76.4%, 42/55) and the proportion of them in NM group was higher than that of in LRS group (23.5%, 4/17 vs 6.8%, 18/266, P = .0418). Although the size of closure device or defect did not show significant differences, the ratios (R = size of closure/size of defect) were significantly higher in NM group than those in WM group (1.40 [1.26, 1.80] vs 1.22 [1.13, 1.38] in AP group, P = .00238; 1.38 [1.23, 1.50] vs 1.22 [1.13, 1.37] in LRS group, P = .024934, respectively). Further logistic regression analysis illustrated that larger R value was a risk factor for NM in AP group (OR 1.48, 95% CI 1.07-2.05, P = .0188). Besides, migraine symptoms decreased significantly after defect closure in PM group among patients with ASD and PFO. CONCLUSION This study revealed several associations between migraine and CHDs, especially the large ratio of closure device size to defect size. High-quality randomized controlled trials and animal studies are needed to further investigate and clarify the underlying association between CHDs and migraine.
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Affiliation(s)
- Yinglu Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Sulei Li
- Department of Cardiology & National Clinical Research Center of Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Rongfei Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xun Han
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Min Su
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiutang Cao
- Department of Medical Statistics, Chinese PLA General Hospital, Beijing, China
| | - Guangyi Wang
- Department of Cardiology & National Clinical Research Center of Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Feng Cao
- Department of Cardiology & National Clinical Research Center of Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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20
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Feng C, Luo T, Luo Y, Zhao N, Huang K, Xiao C. Contrast-enhanced transthoracic echocardiography applied in evaluation of pulmonary right-to-left shunt: A preliminary study. Comput Med Imaging Graph 2018; 68:55-60. [PMID: 30056290 DOI: 10.1016/j.compmedimag.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/13/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the detection rate of patent foramen ovale-right to left shunt (PFO-RLS) and/or pulmonary-right to left shunt (P-RLS) via contrast-enhanced transthoracic echocardiography (c-TTE) in healthy participants, patients suffering from cryptogenic stroke and migraine with aura. METHODS Initially, 20 healthy volunteers, 21 cases with cryptogenic stroke, and 18 cases with migraine aura were randomly selected, and all of them received c-TTE and transesophageal echocardiography (TEE) examinations. First of all, 0.9% sodium chloride solution was rapidly injected into upper extremiry vein, when these volunteers and patients were at rest or following a Valsalva maneuver with 40 mm Hg pressure exerted against a manometer. Secondly, c-TTE detection was carried out in order to distinguish PFO-RLS and P-RLS and make semi-quantitative classification of RLS from many different sources, according to the occurrence and duration time of microvesicles in left atrial after the developing of left atrium. In terms of c-TTE analyses, RLS could be diagnosed when micro bubbles were visualized in transition from the right atrium to the left atrium. Particularly, a small amounts of RLS was 1 level, indicating 1-10 microvesicles per frame could be seen in left atrium, moderate amounts of RLS was 2 level, indicating 11-30 microvesicles per frame could be seen in left atrium, and a large amounts of RLS was 3 level, indicating more than 30 microvesicles per frame, or the left atrium is filled with micro vesicles. RESULTS A total of 20 healthy adult volunteers were identified into this research. RLS was detected in 7 cases, according to c-TTE method (7/20, 35%). In detail, 3 participants suffered from PFO-RLS and P-RSL (3/20, 15%) simultaneously, 5 cases suffered from PFO-RLS (5/20, 25%), and 5 cases suffered from P-RLS (5/20, 25%). Among 21 patients with cryptogenic stroke, RLS was detected in 14 cases, according to cTTE method (14/20, 67%), and then compared with healthy participants group, the difference between them was significant (χ2 = 4.11, P = 0.04). Specifically, 2 participants suffered from PFO-RLS and P-RSL (2/21, 9.5%), 11 cases suffered from PFO-RLS (11/21, 52.4%), and 5 cases suffered from P-RLS (5/21, 23.8%). Among 21 patients suffering from migraine with aura, RLS was detected in 13 cases, according to c-TTE method (13/18, 72%), and then compared with healthy participants group, the difference of detection rate between them was significant (χ2 = 5.2, P = 0.02). In detail, 3 participants suffered from PFO-RLS and P-RSL (3/18, 16.7%), 8 cases suffered from PFO-RLS (8/18, 44.4%), and 8 cases suffered from P-RLS (8/18, 44.4%). In addition, the grading of PFO-RLS in patients suffering from cryptogenic stroke and migraine with aura was mostly grade 2-grade 3. On the contrary, the grading of PFO-RLS in healthy adult volunteers was mostly grade 1-2. Besides, the semi-quantitative grading of P-RLS in each group was mostly grade 1 to grade 2, and difference between healthy volunteer group and cryptogenic stroke group was significant (Z = -2.77, P = 0.006). CONCLUSION P-RLS with lower semiquantitative grade is common in healthy individuals, patients with cryptogenic stroke and migraine aura. And P-RLS can be considered as a significant influencing factor in the pathogenesis of migraine with aura.
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Affiliation(s)
- Cheng Feng
- Department of Ultrasound, The Third People's Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China.
| | - Tingting Luo
- Department of Ultrasound, The Third People's Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China.
| | - Yongfang Luo
- Department of Ultrasound, The Third People's Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China.
| | - Ningbo Zhao
- Department of Ultrasound, The Third People's Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China.
| | - Kun Huang
- Department of Ultrasound, The Third People's Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China.
| | - Chang Xiao
- Department of Ultrasound, The Third People's Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China.
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Migraine with aura and persistent foramen ovale. Eye (Lond) 2017; 32:184-188. [PMID: 29219954 DOI: 10.1038/eye.2017.269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/16/2017] [Indexed: 11/08/2022] Open
Abstract
The association between migraine with aura and persistent foramen ovale (PFO), as well as other right-to-left shunts, is described. A hypothesis that might explain this association is discussed. Observational studies suggested that when a PFO is closed patients who have migraine with aura are usually improved. The Migraine Intervention with STARFlex Technology (MIST) Trial was a randomised double-blind trial in patients with severe intractable migraine with aura and a moderate-large PFO that compared implantation of STARFlex devices with the intention of closing their PFO versus a sham procedure. It was hoped that the trial would demonstrate whether PFO closure would cure migraine. A series of problems in design and execution of the trial are discussed.
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Shi YJ, Lv J, Han XT, Luo GG. Migraine and percutaneous patent foramen ovale closure: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17:203. [PMID: 28747203 PMCID: PMC5530487 DOI: 10.1186/s12872-017-0644-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background The association between patent foramen ovale (PFO) and migraine with aura (MA) is well established. However, the benefits of PFO closure are less certain in patients with migraine without aura (MwoA). Methods We systematically searched Pubmed for pertinent clinical studies published from January 2000 to July 2015. The primary end-point was the elimination or significant improvement of migraine symptoms after PFO closure. Results Upon screening an initial list of 315 publications, we identified eight studies that included 546 patients. Overall, our analysis indicated a significant improvement of migraine in 81% of MA cases compared to only 63% of MwoA cases. The summary odds ratio was 2.5 (95% confidence interval 1.09–5.73), and the benefits of PFO closure were significantly greater for patients with MA compared to patients with MwoA (P = 0.03). Conclusions The presence of aura provides a reference standard for the clinical selection of patients with migraine for PFO closure intervention. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0644-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Jie Shi
- Department of Neurology, Xi'an Jiaotong University, Xi'an, China
| | - Jun Lv
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Xing-Ting Han
- Department of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Guo-Gang Luo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, China.
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Xing YQ, Guo YZ, Gao YS, Guo ZN, Niu PP, Yang Y. Effectiveness and Safety of Transcatheter Patent Foramen Ovale Closure for Migraine (EASTFORM) Trial. Sci Rep 2016; 6:39081. [PMID: 27966652 PMCID: PMC5155423 DOI: 10.1038/srep39081] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/17/2016] [Indexed: 01/03/2023] Open
Abstract
We evaluated the safety and effectiveness of transcatheter patent foramen ovale (PFO) closure for the treatment of migraine in a Chinese population. This non-randomized clinical trial enrolled 258 consecutive substantial or severe migraineurs with a right-to-left shunt (RLS) (grade II–IV) and grouped subjects according to their election or refusal of PFO closure. Migraine was diagnosed according to the International Classification of Headache Disorders III-beta and evaluated using the Headache Impact Test-6 (HIT-6). In total, 241 participants (125 in the transcatheter closure group and 116 in the control group) were included in the study. In general, the PFO closure procedure was found to be safe. At 1 month after closure, 76.1% of patients returned for c-TCD evaluation; of these, 85.7% were downgraded to negative status or a grade-I shunt. Residual shunts and placebo effects were thought to resolve by 12 months post-procedure, when migraine impact was reported to decrease by 73.6%. Transcatheter PFO closure was demonstrated to be effective for the treatment of migraine by comparing HIT-6 scores between the transcatheter closure and control groups (p < 0.001). Our results suggest that transcatheter PFO closure is a safe and effective approach for the treatment of migraine in the Chinese population, especially in females with constant RLS. Clinical trial no. NCT02127294 (registered on April 29, 2014).
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Affiliation(s)
- Ying-Qi Xing
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
| | - Yu-Zhu Guo
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China.,Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yong-Sheng Gao
- Department of Cardiac Surgery, the First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
| | - Peng-Peng Niu
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
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Tariq N, Tepper SJ, Kriegler JS. Patent Foramen Ovale and Migraine: Closing the Debate--A Review. Headache 2016; 56:462-78. [PMID: 26952049 DOI: 10.1111/head.12779] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 12/26/2015] [Accepted: 12/27/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND A link between patent foramen ovale (PFO) and migraine as well as the utility of closure of PFO and its effect on migraine have been subjects of debate. The present review is an effort to gather the available evidence on this topic and formulate recommendations. METHODS A systematic search of electronic databases (Medline, Embase, Cochrane Library) was performed. A separate search in associated reference lists of identified studies was done. Observational studies and clinical trials published in English using the International Headache Society criteria for diagnosis of migraine were included in the analysis. The search was performed in 3 categories: prevalence of migraine in patients with PFO, prevalence of PFO in migraine patients, and effect of PFO closure and its effect on migraine. The quality of evidence and strength of recommendations during review of these studies was analyzed. RESULTS About 14 observational studies with 2602 subjects who had PFO were identified. Migraine prevalence ranged from 16% to 64%. Another 20 studies reported 2444 patients with migraine; the prevalence of PFO ranged from 15% to 90%. About 20 observational studies (1194 patients) that examined the effect of PFO closure on migraine were identified. Resolution of migraine was reported in 10% to 83% of patients, improvement in 14% to 83%, no change in 1% to 54%, and worsening in 4% to 8%. The overall quality of these observational studies was poor. Finally, 3 randomized clinical trials included a total of 238 patients who underwent PFO closure compared with 234 patients in the control groups. All 3 trials failed to meet their primary end points defined as migraine resolution and greater than 50% reduction in migraine days at 1 year. In 2 of the clinical trials, there was some benefit noted in a small subset of migraine patients with aura, but the numbers were too small to extrapolate the findings to the general migraine population. CONCLUSIONS There is no good quality evidence to support a link between migraine and PFO. Closure of PFO for migraine prevention does not significantly reduce the intensity and severity of migraine. We do not recommend the routine use of this procedure in current practice.
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Affiliation(s)
- Nauman Tariq
- Michigan Headache and Neurological Institute Ringgold standard institution - Neurology, Ann Arbor, Michigan, USA
| | - Stewart J Tepper
- Dartmouth College Geisel School of Medicine Ringgold standard institution - Neurology, Hanover, New Hampshire, USA
| | - Jennifer S Kriegler
- Cleveland Clinic - Center for Neurological Restoration, Cleveland, Ohio, USA
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Right-to-Left Shunt Does Not Increase the Incidence of Silent Lacunar Infarcts in Patients with Migraine. BIOMED RESEARCH INTERNATIONAL 2015; 2015:749745. [PMID: 26266262 PMCID: PMC4523651 DOI: 10.1155/2015/749745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/23/2015] [Indexed: 11/29/2022]
Abstract
Right-to-left shunt (RLS) is associated with cryptogenic stroke and migraine. Herein we investigated the relationship between RLS and silent lacunar infarcts in patients with migraine. A total of 263 patients with migraine who met eligibility criteria were enrolled from January 2010 to December 2011, among which 127 subjects fell into RLS group. Baseline demographics were comparable between RLS and non-RLS groups (P > 0.05). The incidence of silent lacunar infarcts in RLS group was not significantly different from that of the non-RLS group (25.2% versus 21.3%, P > 0.05). Furthermore, we found that the incidence of silent lacunar infarcts in permanent and latent RLS subgroups was comparable with non-shunt RLS subgroup (28.6% versus 24% versus 21.3%, P > 0.05). Similarly, the incidence of silent lacunar infarcts in the non-RLS group, mild-shunt group, and large-shunt group was also comparable (21.3% versus 23.8% versus 29.3%, P > 0.05). In addition, RLS did not increase the incidence of silent lacunar infarcts in migraine patients with elder age (<50 years age group: 15.8% versus 17.9%; ≥50 years age group: 53.1% versus 37.5%, both P > 0.05). In conclusion, RLS does not increase the incidence of silent lacunar infarcts in patients with migraine. Further prospective studies are warranted to validate this finding.
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Kahya Eren N, Bülbül NG, Yakar Tülüce S, Nazlı C, Beckmann Y. To Be or Not to Be Patent: The Relationship Between Migraine and Patent Foramen Ovale. Headache 2015; 55:934-42. [DOI: 10.1111/head.12618] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Nihan Kahya Eren
- Cardiology Department; Izmir Katip Celebi University Ataturk Education and Research Hospital; Izmir Turkey
| | - Nazlı G. Bülbül
- Neurology Department; Izmir Katip Celebi University Ataturk Education and Research Hospital; Izmir Turkey
| | - Selcen Yakar Tülüce
- Cardiology Department; Izmir Katip Celebi University Ataturk Education and Research Hospital; Izmir Turkey
| | - Cem Nazlı
- Cardiology Department; Izmir Katip Celebi University Ataturk Education and Research Hospital; Izmir Turkey
| | - Yeşim Beckmann
- Neurology Department; Izmir Katip Celebi University Ataturk Education and Research Hospital; Izmir Turkey
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Abstract
The clinical significance of persistent patent foramen ovale (PFO) is not well defined. Empirically, PFO has been associated with many clinical conditions. In cryptogenic stroke, migraine, and orthodeoxia/platypnea, a plausible biologic mechanism exists to support PFO closure as a possible treatment. Although transcatheter closure of PFO has been available for over 2 decades, it has remained controversial due to a paucity of evidence to guide patient and device selection. Contemporary studies investigating PFO closure as treatment for patients with these conditions have been published recently and longitudinal data regarding the safety and efficacy of the devices is now available. In this review, we aim to describe the potential clinical significance of a patent foramen in the adult, appraise the newest additions to the body of evidence, and discuss the safety, benefit, patient selection, and future of transcatheter treatment of PFO.
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Affiliation(s)
- N Rohrhoff
- Duke University Medical Center, 3331 DUMC, Durham, NC, 27710, USA
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Matsumura K, Gevorgyan R, Mangels D, Masoomi R, Mojadidi MK, Tobis J. Comparison of residual shunt rates in five devices used to treat patent foramen ovale. Catheter Cardiovasc Interv 2014; 84:455-63. [DOI: 10.1002/ccd.25453] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/27/2014] [Accepted: 02/16/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Koichiro Matsumura
- Program in Interventional Cardiology Division of Cardiology; David Geffen School of Medicine, University of California at Los Angeles; Los Angeles California
| | - Rubine Gevorgyan
- Program in Interventional Cardiology Division of Cardiology; David Geffen School of Medicine, University of California at Los Angeles; Los Angeles California
| | - Daniel Mangels
- Program in Interventional Cardiology Division of Cardiology; David Geffen School of Medicine, University of California at Los Angeles; Los Angeles California
| | - Reza Masoomi
- Program in Interventional Cardiology Division of Cardiology; David Geffen School of Medicine, University of California at Los Angeles; Los Angeles California
| | - Mohammad Khalid Mojadidi
- Program in Interventional Cardiology Division of Cardiology; David Geffen School of Medicine, University of California at Los Angeles; Los Angeles California
| | - Jonathan Tobis
- Program in Interventional Cardiology Division of Cardiology; David Geffen School of Medicine, University of California at Los Angeles; Los Angeles California
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Abstract
Percutaneous patent foramen ovale (PFO) closure is a treatment for cryptogenic stroke and migraine headache. The goal of this study was to assess long-term outcomes of patients treated with percutaneous PFO closure. Records of patients with percutaneous PFO closure at Emory University Hospital from February 2002 to July 2009 were reviewed. Follow-up telephone questionnaire and chart review assessed recurrent stroke, migraine, and complications. Data was reviewed on 414 consecutive patients. Long-term follow-up was obtained in 207 of patients, and mean follow up was 4.6 ± 2.0 years. Cryptogenic stroke was the primary indication for intervention in 193 (93%) patients. Thirteen (7%) patients had a recurrent neurologic event post closure. In patients with multiple neurological events at baseline, 17% (n = 11) had a recurrent event, compared with 2% (n = 2) of patients with a single neurological event prior to PFO-closure (P < 0.002). Post closure, migraine frequency and severity declined from 4.5 to 1.1 migraine/month (P < 0.01) and 7.2 to 3.6 out of 10 (P < 0.01) in patients with history of migraine (n = 60). Thirty-day mortality was 1% (n = 2). One patient had device erosion 5 years post-procedure requiring emergent surgery. Atrial fibrillation was newly diagnosed in 8 (4%) patients within 6 months. In conclusion, the long-term rate of recurrent stroke after PFO closure is low in patients with a single neurological event at baseline. Serious long-term complications after PFO closure are rare. PFO closure may decrease the frequency and severity of migraine.
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Evola S, Kauroo BW, Trovato RL, Alioto L, D'Amico G, Fonte G, Andolina G, Novo S, Assennato P. The percutaneous closure of patent foramen ovale (PFO): Impact on the quality of life. Int J Cardiol 2013; 168:1622-3. [DOI: 10.1016/j.ijcard.2013.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
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A right-to-left shunt and prothrombotic disorders in pediatric patients presenting with transient ischemic attack. Eur J Pediatr 2013; 172:239-45. [PMID: 23108849 DOI: 10.1007/s00431-012-1875-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
Arterial ischemic stroke is an important cause of morbidity and mortality in pediatric population. A right-to-left shunt (RLS) across the patent foramen ovale was recently demonstrated as a possible risk factor for pediatric stroke. Prothrombotic disorders are frequently identified in pediatric patients with stroke. Data regarding RLS and prothrombotic disorders in pediatric patients presenting with transient ischemic attack (TIA) are lacking. The aims of the present study were (1) to compare the prevalence and grade of RLS in pediatric patients presenting with TIA vs. controls using contrast transcranial Doppler with Valsalva maneuver and (2) to identify prothrombotic disorders in pediatric patients presenting with TIA. Twenty-three consecutive pediatric patients presenting with TIA were included in the study. Logistic regression analysis showed that RLS was significantly associated with TIA (OR 4.75, 95 % CI 1.39-16.2, p = 0.013). The prevalence of RLS was significantly higher in patients in comparison to controls (p = 0.019). Significantly more microembolic signals (MES) were detected in patients than in controls (p = 0.003). Prothrombotic disorders were identified in 14 of the 23 patients. Both the prevalence of RLS and number of detected MES were significantly higher in pediatric patients presenting with TIA in comparison to controls. Prothrombotic disorders were identified in a high proportion of patients. These findings suggest that paradoxical embolism may be important in pediatric patients presenting with TIA.
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Sinclair AJ, Matharu M. Migraine, cerebrovascular disease and the metabolic syndrome. Ann Indian Acad Neurol 2012; 15:S72-7. [PMID: 23024568 PMCID: PMC3444221 DOI: 10.4103/0972-2327.100015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 02/09/2012] [Indexed: 11/08/2022] Open
Abstract
Evidence is emerging that migraine is not solely a headache disorder. Observations that ischemic stroke could occur in the setting of a migraine attack, and that migraine headaches could be precipitated by cerebral ischemia, initially highlighted a possibly association between migraine and cerebrovascular disease. More recently, large population-based studies that have demonstrated that migraineurs are at increased risk of stroke outside the setting of a migraine attack have prompted the concept that migraine and cerebrovascular disease are comorbid conditions. Explanations for this association are numerous and widely debated, particularly as the comorbid association does not appear to be confined to the cerebral circulation as cardiovascular and peripheral vascular disease also appear to be comorbid with migraine. A growing body of evidence has also suggested that migraineurs are more likely to be obese, hypertensive, hyperlipidemic and have impaired insulin sensitivity, all features of the metabolic syndrome. The comorbid association between migraine and cerebrovascular disease may consequently be explained by migraineurs having the metabolic syndrome and consequently being at increased risk of cerebrovascular disease. This review will summarise the salient evidence suggesting a comorbid association between migraine, cerebrovascular disease and the metabolic syndrome.
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Affiliation(s)
- Alexandra J Sinclair
- Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Kang KW, Kim JT, Chang J, Choi WH, Lim D, Bang DH, Choi YJ. Transient Sulcal Hyperintensities on Fluid-Attenuated Inversion Recovery in Migraine With Aura. Headache 2012; 52:1430-3. [DOI: 10.1111/j.1526-4610.2012.02230.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yoon GJ, Kim JT, Chang J, Kim DE, Cho BH, Lee JH, Jung HJ, Lee SH, Choi SM, Park MS, Cho KH. Right-to-left shunts as a cause of juxtacortical spots in patients with migraine. Eur J Neurol 2012; 19:1086-92. [PMID: 22360723 DOI: 10.1111/j.1468-1331.2012.03680.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUNDS Juxtacortical spots on fluid-attenuated inversion recovery (FLAIR) images can be frequently detected in patients with migraine. However, the origins of the cerebral lesions (including juxtacortical spots on FLAIR images) found in the previous studies are not known. We sought to investigate the association between juxtacortical spots on FLAIR images and right-to-left shunt (RLS) in migraine patients. METHODS Juxtacortical spots on FLAIR images were arbitrarily defined as small areas of hyperintensities in the juxtacortex and cortico-subcortical junction. The presence of RLS was examined by a transcranial Dopper (TCD) with the agitated saline test. The degree of RLS was categorized into four grades according to the number of microemboli: no shunt, <10 microbubbles (MB), >10 MB single spots pattern, and >10 MB shower/curtain pattern. We compared the results for migraine patients (n = 49) with those for healthy controls (n = 49). RESULTS Juxtacortical spots on FLAIR images occurred in 38/98 subjects; of them, 27/49 (55.1%) had migraines and 11/49 (22.2%) were healthy controls (P = 0.002). The independent factors associated with juxtacortical spots on FLAIR images were female, migraine patients, and RLS by multivariate analysis. In migraine patients, RLS was independently associated with juxtacortical spots on FLAIR images. CONCLUSION Our results suggest that juxtacortical spots on FLAIR images were frequently found in migraine patients and might be associated with the presence of RLS in those patients. Further studies are needed to assess whether juxtacortical spots have clinical implications in patients with migraine.
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Affiliation(s)
- G-J Yoon
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
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36
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He M, Yu S, Wang G. One case of sporadic hemiplegic migraine with multiple pulmonary arteriovenous malformation. J Headache Pain 2011; 12:369-71. [PMID: 21246241 PMCID: PMC3094664 DOI: 10.1007/s10194-011-0292-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/01/2011] [Indexed: 11/28/2022] Open
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Trabattoni D, Fabbiocchi F, Montorsi P, Galli S, Teruzzi G, Grancini L, Gatto P, Bartorelli AL. Sustained long-term benefit of patent foramen ovale closure on migraine. Catheter Cardiovasc Interv 2011; 77:570-4. [DOI: 10.1002/ccd.22826] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 09/11/2010] [Indexed: 11/09/2022]
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Rigatelli G. Congenital heart conditions: the 'headache' of assessing a link between PFO and migraine. Nat Rev Cardiol 2010; 7:361-2. [PMID: 20577294 DOI: 10.1038/nrcardio.2010.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The relationship between patent foramen ovale and migraine is a hotly debated issue. Conflicting data on the association or independence of these conditions have been reported by various study groups around the world. Now, a large-scale case-control study has shown no association between the two entities; however, there were a number of methodological flaws in this study and we are unlikely to see the end of the controversy in the near future.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Via W. A. Mozart 9, 37040 Legnago, Verona, Italy.
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Noheria A, Roshan J, Kapa S, Srivathsan K, Packer DL, Asirvatham SJ. Migraine headaches following catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2010; 30:227-32. [DOI: 10.1007/s10840-010-9519-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 09/19/2010] [Indexed: 10/18/2022]
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40
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Providencia RA. Headache and cardiovascular disease: old symptoms, new proposals. Future Cardiol 2010; 6:703-23. [DOI: 10.2217/fca.10.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Evidence of a link between headache symptoms and cardiovascular disease has rapidly grown in recent years and it is of utmost importance for the cardiologist and neurologist to be aware of this intimate connection. A brief overview of different cardiovascular diseases (namely hypertension, stroke, coronary heart disease, patent foramen ovale, atrial septal defects, atrial septal aneurisms, mitral valve prolapse, and aortic and carotid disease) that may be related to headache is presented in this article. Proposed pathophysiological mechanisms for this association and landmark studies are reviewed and discussed.
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Amaral V, Freitas GRD, Rodrigues BC, Christoph DDH, Pinho CAD, Góes CDFP, Vincent MB. Patent foramen ovale in trigeminal autonomic cephalalgias and hemicrania continua: a non-specific pathophysiological occurrence? ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:627-31. [DOI: 10.1590/s0004-282x2010000400028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 02/09/2010] [Indexed: 11/21/2022]
Abstract
Patent foramen ovale (PFO), a relatively common abnormality in adults, has been associated with migraine. Few studies also linked PFO with cluster headache (CH). To verify whether right-to-left shunt (RLS) is related to headaches other than migraine and CH, we used transcranial Doppler following microbubbles injection to detect shunts in 24 CH, 7 paroxysmal hemicrania (PH), one SUNCT, two hemicrania continua (HC) patients; and 34 matched controls. RLS was significantly more frequent in CH than in controls (54% vs. 25%, p=0.03), particularly above the age of 50. In the HC+PH+SUNCT group, RLS was found in 6 patients and in 2 controls (p=0.08). Smoking as well as the Epworth Sleepiness Scale correlated significantly with CH, smoking being more frequent in patients with RLS. PFO may be non-specifically related to trigeminal autonomic cephalalgias and HC. The headache phenotype in PFO patients probably depends on individual susceptibility to circulating trigger factors.
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Rigatelli G, Dell'avvocata F, Cardaioli P, Ronco F, Giordan M, Braggion G, Aggio S, Chinaglia M, Cheng JP, Nanjundappa A. Left atrial dysfunction in patients with patent foramen ovale and atrial septal aneurysm scheduled for transcatheter closure may play a role in aura genesis. J Interv Cardiol 2010; 23:370-6. [PMID: 20624202 DOI: 10.1111/j.1540-8183.2010.00563.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It has been suggested that a left atrial (LA) dysfunction induced by large shunt and large atrial septal aneurysm (ASA) may act as a concurrent mechanism of arterial embolism in patients with patent foramen ovale (PFO) and prior stroke. We aimed to evaluate the potential contribution of this mechanism as trigger of migraine in patients with PFO. METHODS From January 2007 to September 2009, we prospectively enrolled subjects with migraine who underwent percutaneous PFO closure. Echocardiographic parameter of LA dysfunction was evaluated: pre- and postoperative values were compared to values of different sex and heart rate matched populations: 30 healthy patients, 21 migraine patients without PFO (MwoPFO), and a group of 25 PFO patients without migraine (PFOwoM). The Migraine Disability Assessment Score (MIDAS) was used to assess the incidence and severity of migraine. RESULTS Forty-five patients (38 females, mean age 38 +/- 6.7 years, mean MIDAS 35.8 +/- 4.7, and 28 patients with migraine with aura) fulfilled the inclusion criteria. After successful percutaneous closure (mean follow-up of 18.2 +/- 4.8 months), PFO closure remained complete in 95%; 35 of 45 patients reported resolution or amelioration of migraine (mean MIDAS score 12.3 +/- 8.8, P < 0.03). All patients with aura reported aura resolution. Preclosure values demonstrated significantly greater LA dysfunction, when compared with healthy and MwoPFO groups. Among patients in the study group, only patients with migraine with aura showed LA dysfunction comparable to PFOwoM patients. CONCLUSION This study suggests that LA dysfunction probably does not contribute to migraine itself but may play a role in the genesis of aura symptoms.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
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Caputi L, Usai S, Carriero MR, Grazzi L, D'Amico D, Falcone C, Anzola GP, Del Sette M, Parati E, Bussone G. Microembolic Air Load During Contrast-Transcranial Doppler: A Trigger for Migraine With Aura? Headache 2010; 50:1320-7. [DOI: 10.1111/j.1526-4610.2010.01621.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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CHILUKURI KARUNA, SINHA SUNIL, BERGER RONALD, MARINE JOSEPHE, CHENG ALAN, NAZARIAN SAMAN, SCHERR DANIEL, SPRAGG DAVID, CALKINS HUGH, HENRIKSON CHARLESA. Association of Transseptal Punctures with Isolated Migraine Aura in Patients Undergoing Catheter Ablation of Cardiac Arrhythmias. J Cardiovasc Electrophysiol 2009; 20:1227-30. [DOI: 10.1111/j.1540-8167.2009.01525.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Rogers JH, Smith TW. Eliminating right-to-left shunt with patent foramen ovale closure: not as simple as it seems. JACC Cardiovasc Interv 2009; 2:568-9. [PMID: 19539263 DOI: 10.1016/j.jcin.2009.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 04/16/2009] [Indexed: 11/30/2022]
MESH Headings
- Balloon Occlusion/instrumentation
- Blood Circulation
- Embolism, Paradoxical/diagnostic imaging
- Embolism, Paradoxical/etiology
- Embolism, Paradoxical/physiopathology
- Embolism, Paradoxical/prevention & control
- Foramen Ovale, Patent/complications
- Foramen Ovale, Patent/diagnostic imaging
- Foramen Ovale, Patent/physiopathology
- Foramen Ovale, Patent/therapy
- Humans
- Intracranial Embolism/diagnostic imaging
- Intracranial Embolism/etiology
- Intracranial Embolism/physiopathology
- Intracranial Embolism/prevention & control
- Secondary Prevention
- Time Factors
- Treatment Outcome
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Transcranial
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Zaletel M, Zvan B, Koželj M, Prokšelj K, Podnar T, Berden P, Mishaly D. Migraine With Aura Induced by Artificial Microbubbles. Cephalalgia 2009; 29:480-3. [DOI: 10.1111/j.1468-2982.2008.01757.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Zaletel
- Department of Neurology, University Clinical Centre Ljubljana
| | - B Zvan
- Department of Neurology, University Clinical Centre Ljubljana
| | - M Koželj
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta
| | - K Prokšelj
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta
| | - T Podnar
- Department of Pediatrics, Vrazov trg, Ljubljana, Slovenia
| | - P Berden
- Department of Radiology, University Medical Centre Ljubljana, Zaloška cesta
| | - D Mishaly
- The Chaim Sheba Medical Center, Department of Pediatric Cardiovascular Surgery, Tel Hashomer, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Izrael
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Álvarez-Fernández J, Alarcón-Fernández O, Pérez-Quintero R. Contribución del foramen oval permeable a la etiopatogenia del síndrome de intestino irritable. Rev Clin Esp 2009; 209:136-40. [DOI: 10.1016/s0014-2565(09)70879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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48
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Closure of patent foramen ovale in the prevention of migraine: not enough evidence in favor. ACTA ACUST UNITED AC 2008; 5:22-3. [DOI: 10.1038/ncpneuro0971] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Accepted: 11/03/2008] [Indexed: 11/08/2022]
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49
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Patent foramen ovale and migraine: an example of heart-brain interaction. ACTA ACUST UNITED AC 2008; 5:20-1. [PMID: 19048003 DOI: 10.1038/ncpneuro0969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 11/03/2008] [Indexed: 11/08/2022]
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50
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Sherin C, Francesca F, Karl P, Brendan T, Ron H, Lyn G. Investigation between the S377G3 GATA-4 polymorphism and migraine. Open Neurol J 2008; 2:35-8. [PMID: 19018306 PMCID: PMC2577932 DOI: 10.2174/1874205x00802010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 04/09/2008] [Accepted: 06/11/2008] [Indexed: 12/28/2022] Open
Abstract
Migraine is a common and painful neurological disorder, with genetic and environmental components. Several conditions have been shown to be comorbid with migraine, notably a cardiac malformation affecting the interatrial septum and leading to patent foramen ovale (PFO). Mutations in the development regulatory gene GATA-4, located on human chromosome 8p23.1-p22, have been found to be responsible for some cases of congenital heart defects including PFO. To determine whether the GATA-4 gene is involved in migraine, the present study performed an association analysis of a common GATA-4 variant that results in a change of amino acid (S377G), in a large case/control population (275 unrelated Caucasian migraineurs versus 275 control individuals). The results showed that there was no significant association for this polymorphism between migraine and controls (chi(2) = 0.84, P = 0.66). Thus it appears that the GATA-4 (S377G) mutation does not play a significant role in common migraine susceptibility.
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Affiliation(s)
- Chikhani Sherin
- Genomics Research Centre, Griffith University, Gold Coast, Queensland, Australia
| | - Fernandez Francesca
- Genomics Research Centre, Griffith University, Gold Coast, Queensland, Australia
| | - Poetter Karl
- Genera Biosystems Pty Ltd, Bundoora, Victoria, Australia
| | - Toohey Brendan
- Genera Biosystems Pty Ltd, Bundoora, Victoria, Australia
| | - Harvey Ron
- The Victor Cardiac Research Institute, St. Vincents Hospital, Darlinghurst, Australia
| | - Griffiths Lyn
- Genomics Research Centre, Griffith University, Gold Coast, Queensland, Australia
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