Article

Patent foramen ovale and migraine: A systematic review

Washington University School of Medicine, Washington University Headache Center, St Louis, MO, USA.
Cephalalgia (Impact Factor: 4.12). 06/2008; 28(5):531-40. DOI: 10.1111/j.1468-2982.2008.01554.x
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ABSTRACT Initial studies indicate an increased prevalence of patent foramen ovale (PFO) in migraineurs with aura, and an increased prevalence of migraine and migraine with aura in persons with PFO. Retrospective analyses of PFO closure suggest clinically significant improvements in migraine patterns. The aim of this study was to examine the prevalence of migraine in patients with PFO, the prevalence of PFO in migraineurs, and the effect of PFO closure on migraine. We conducted a quantitative systematic review of articles on migraine and PFO that met inclusion criteria, then reviewed, appraised, and subjected them to data extraction. Of 134 articles identified, 18 met a priori selection criteria. The estimated strength of association between PFO and migraine, reflected by summary odds ratios (ORs), was 5.13 [95% confidence interval (CI) 4.67, 5.59], and between PFO and migraine with aura the OR was 3.21 (95% CI 2.38, 4.17). The grade of evidence was low. The association between migraine and PFO was OR 2.54 (95% CI 2.01, 3.08). The grade of evidence was low to moderate. Six studies of PFO closure suggested improvement in migraine, but had a very low grade of evidence. The low-to-moderate grade of evidence from observational studies supports an apparent association between PFO and migraine. Although PFO closure seemed to affect migraine patterns favourably, the very low grade of available evidence to support this association precludes definitive conclusions.

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    • "It is noteworthy that while the effect obtained with low dose aspirin is completely imputable to the antiplatelet effect of the drug, it is likely that aspirin at high dose might be effective to relief migraine pain because of its putative analgesic action. As regards the management of patients with patent foramen ovale (PFO), it is known that closure of PFO may relieve migraine, but placement of an Amplatzer occluder may also trigger or aggravate migraine in a number of patients [89]. A recent study found that after transcatheter PFO closure, clopidogrel plus aspirin is superior over aspirin alone in preventing migraine with aura [90]. "
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    ABSTRACT: The pathogenesis of migraine, the third most frequent disease worldwide, is complex and multifaceted. Recent evidence suggests that this condition should be considered as a primary neurovascular disorder. The pathogenesis is sustained by a relative reduction of cerebral blood flow, which is then followed by reactive hyperaemia, sterile inflammation and hypersensitization of pain pathways. The leading triggers of the initial vasoconstriction entail both hereditary or acquired cerebrovascular disorders, namely local endothelial or smooth muscle dysfunction, arteriovenous malformations autoimmune and inflammatory disorders, along with cerebral microembolism. The existence of a potential relationship between platelet biology and migraine has been hypothesized more than 30 years ago, paving the way to a series of subsequent studies. Despite the clinical evidence that patients with essential thrombocythemia have a high frequency of headache symptoms, the epidemiological trials that have investigated the platelet count in patients with an accurate diagnosis of migraine failed to report significant associations. Conversely, several lines of evidence attest that serotonin metabolism is substantially impaired in migraine patients, thus contributing to trigger or enhance vasoconstriction and hypersensitization of neuronal elements. Although abnormalities of nitric oxide metabolism should be confirmed in larger studies, published data suggests that this compound may be effective to amplify the reactive vasodilatation that specifically follows the initial reduction of cerebral blood flow. Another plausible link between platelet biology and migraine is represented by inflammation. Increased release of several proinflammatory cytokines, especially interleukins 1, 6 and 8 and tumor necrosis factor-alpha, may occur after formation of platelet-leukocyte aggregates, and these mediators can further contribute to increase sterile inflammation in the brain and facilitate pain signalling.
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    • "It is important to establish the prevalence because of a growing trend towards percutaneous closure. In patients with cryptogenic stroke or decompression sickness in divers, closure of a PFO [3] [4], but not of an ASD [5], has been reported to reduce coexistent migraine. Non-randomised trials have suggested that closure is a reasonable treatment for migraine as sole pathology [6] [7] [8], but the only randomised trial [9] showed no effect. "
    Dataset: IJCA16474
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    • "It is important to establish the prevalence because of a growing trend towards percutaneous closure. In patients with cryptogenic stroke or decompression sickness in divers, closure of a PFO [3] [4], but not of an ASD [5], has been reported to reduce coexistent migraine. Non-randomised trials have suggested that closure is a reasonable treatment for migraine as sole pathology [6] [7] [8], but the only randomised trial [9] showed no effect. "
    Dataset: IJCA16474
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