Recent studies reported an increased prevalence of patent foramen ovale (PFO) in patients with migraine with aura (MA+). To investigate the possible relationship between MA+ and paradoxical embolism, we studied the prevalence of both conditions. Investigation of PFO was undertaken in 74 consecutive patients presenting with an acute stroke of undetermined origin. The patients were questioned about MA+ or migraine without aura (MA–) according to the criteria of the International Headache Society. Follow-up was performed to investigate the evolution of MA+ and MA– according to different treatments of stroke. PFO was found in 44 of 74 patients, 16 of whom had MA+ (36%), compared to 4 (13%) MA+ patients without PFO (p = 0.03). Of 25 patients in whom the PFO was considered to play a causal role in the stroke, 13 (52%) had MA+, whereas only 3 (16%) of 19 patients in whom PFO was considered unrelated had MA+ (p = 0.014). Thirty-nine of the patients with MA+ and MA– were studied over a mean follow-up of 13 months. Seven of 15 patients with MA+ and PFO, treated either with surgical closure or anticoagulants, noticed complete disappearance of MA+ attacks. The prevalence of MA+ is high among stroke patients with PFO. In patients with a high presumption of paradoxical embolism, the proportion of MA+ is increased, and this suggests a possible role of this association in the occurrence of the cerebrovascular event. Forty-seven percent of patients with PFO and MA+ reported complete suppression of their aura attacks after surgical closure or anticoagulant treatment. This finding suggests that at least in some patients, MA+ attacks may be due to paradoxical embolism.

Keywords:
Migraine, Stroke, Patent foramen ovale, Transcranial Doppler
1.
Olesen J, Friberg L, Olsen TS, Andersen AR, Lassen NA, Hansen PE, Karle A: Ischaemia-induced (symptomatic) migraine attacks may be more frequent than migraine-induced ischaemic insults. Brain 1993;116:187–202.
2.
Welch KMA: Relationship of stroke and migraine. Neurology 1994;44(suppl 7):S33–S36.
3.
Rothrock J, Madden K, Lyden P, Fleck P, Dittrich H: Migraine and migrainous stroke: Risk factors and prognosis. Neurology 1993;43:2473–2476.
4.
Ries S, Steinke W, Neff W, Schindlmayr C, Mears S, Hennerici M: Ischemia-induced migraine from paradoxical cardioembolic stroke. Eur Neurol 1996;36:76–78.
5.
Del Sette M, Angeli S, Leandri M, Ferriero G, Bruzzone GL, Finocchi C, Gandolfo C: Migraine with aura and right-to-left shunt on transcranial Doppler: A case-control study. Cerebrovasc Dis 1998;8:327–330.
6.
Anzola GP, Magoni M, Guindani M, Rozzini L, Dalla Volta G: Potential source of cerebral embolism in migraine with aura: A transcranial Doppler study. Neurology 1999;52:1622–1625.
7.
Wilmshurst PT, Nightingale S, Walsh KP, Morrison WL: Effect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons. Lancet 2000;356:1648–1651.
8.
Bogousslavsky J, Garazi S, Jeanrenaud X, Aebischer N, Van Melle G: Stroke recurrence in patients with patent foramen ovale: The Lausanne study. Lausanne Stroke with Paradoxal Embolism Study Group. Neurology 1996;46:1301–1305.
9.
Welch KMA, Levine SR: Migraine-related stroke in the context of the International Headache Society classification of head pain. Arch Neurol 1990;47:458–462.
10.
Shuaib A: Stroke from other etiologies masquerading as migraine-stroke. Stroke 1991;22:1068–1074.
11.
Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S: Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 1992;117:461–465.
12.
Lechat P, Mas JL, Lascault G, Loron P, Theard M, Klimczac M, Drobinski G, Thomas D, Grosgogeat Y: Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988;318:1148–1152.
13.
Kitano A, Shimomura T, Takeshima T, Takahashi K: Increased 11-dehydrothromboxane B2 in migraine: Platelet hyperfunction in patients with migraine during headache periods. Headache 1994;34:515–518.
14.
Olesen J, Larsen B, Lauritzen M: Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine. Ann Neurol 1981;9:344–352.
15.
Vestergaard K, Andersen G, Nielsen MI, Jensen TS: Headache in stroke. Stroke 1993;24:1621–1623.
16.
Homma S, Di Tullio MR, Sacco RL, Mihalatos D, Li Mandri G, Mohr JP: Characteristics of patent foramen ovale associated with cryptogenic stroke. A biplane transesophageal echocardiographic study. Stroke 1994;25:582–586.
17.
Fragoso YD: Reduction of migraine attacks during the use of warfarin. Headache 1997;37:667–668.
18.
Van Puijenbroek EP, Egberts JF, Trooster JFG, Zomerdijk J: Reduction of migrainous headaches during the use of acenocoumarol. Headache 1996;36:48.
19.
Morales-Asin F, Iniguez C, Cornudella R, Mauri J-A, Espada F, Mostacero E: Patients with acenocoumarol treatment and migraine. Headache 2000;40:45–47.
© 2002 S. Karger AG, Basel
2002
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