偏头痛与卵圆孔未闭研究进展

Update advance in migraine and patent foramen ovale

偏头痛是临床常见的神经系统疾病,全球患病率约15%,疾病负担沉重。卵圆孔未闭是最常见的先天性心脏异常,也是导致右向左分流的最主要原因。卵圆孔未闭与偏头痛尤其是有先兆偏头痛之间存在双向关系,二者共病率显著高于普通人群。其病理生理学机制尚不明确,目前认为反常栓塞和血管活性物质可能是二者共病的基础。经导管卵圆孔未闭封堵术可以减少头痛发作频率和持续时间,但其有效性尚存争议。有先兆偏头痛、应用抗血小板药物、大量右向左分流、共病缺血性卒中或短暂性脑缺血发作的患者可能更易从经导管卵圆孔未闭封堵术中获益。未来尚待更多多中心、前瞻性、双盲、随机、对照临床试验明确经导管卵圆孔未闭封堵术对偏头痛预防治疗的远期疗效和预测因素,为临床选择行经导管卵圆孔未闭封堵术的适宜患者提供依据。

Migraine is a common neuro-vascular disease with a global prevalence of about 15% and a heavy burden. Patent foramen ovale(PFO)is the most common congenital cardiac abnormality consisting of the main cause of right-to-left shunt(RLS). There is a correlation between PFO and migraine, especially migraine with aura(MA). The comorbidity rate of PFO and migraine is significantly higher than that of the general population. The exact pathophysiological mechanism of comorbidity between PFO and migraine is unclear. At present, it is considered that paradoxical embolism and vasoactive peptides may underlie this comorbidity. Some studies suggest that percutaneous closure of PFO can reduce the frequency and duration of migraine, but the effectiveness of closure of PFO is still controversial. At present, limited evidence suggests that migraine with aura, antiplatelet drugs, large amount of RLS, and comorbid with ischemic stroke and transient ischemic attack(TIA)may benefit more from closure of PFO. In the future, more multicenter, prospective, double-blind, randomized controlled large-scale clinical studies are needed to clarify the long-term efficacy and predictive factors of closure of PFO on migraine prophylactic treatment, so as to provide criteria for screening the eligible patients treated with closure of PFO.