Background: Patent foramen ovale(PFO) has been implicated in the etiology of migraine headache with aura(MHA), but the mechanisms that link right-to-left(R-to-L) shunt to MHA are unclear, and the reports on the effica...Background: Patent foramen ovale(PFO) has been implicated in the etiology of migraine headache with aura(MHA), but the mechanisms that link right-to-left(R-to-L) shunt to MHA are unclear, and the reports on the efficacy of transcatheter PFO closure on MHA prevention are scarce. Methods: We reviewed the clinical records of 131 consecutive patients who underwent successful transcatheter PFO closure at our institution at a mean age of 45±13 years because of cryptogenic stroke. Of the 131 patients, 35(27%) had a diagnosis of MHA made by the primary care physician or the referring neurologist. Migraine headache with aura incidence and severity were assessed by using Migraine Disability Assessment(MIDAS) questionnaire. Presence and magnitude of R-to-L shunt were assessed in all patients by means of transesophageal echocardiography and also by means of transcranial Doppler(TCD) in the last 50 patients(38%). Results: Patients with MHA had a higher prevalence of thrombophilia(P=.007), a more complex atrial septal anatomy(P=.001), and they also had higher prevalence of spontaneous R-to-L shunt and of spontaneous large shunt,both at transesophageal echocardiography(P=.015, and .028, respectively) and at TCD(P=.036, and .038, respectively). After the procedure, 32(91%) of 35 patients had either complete resolution or significant improvement in their MHA. At a mean follow-up of 1.7±1.3 years, MHA disappeared completely in 29(83%) of 35 patients. Of the remaining 6 patients, 3 patients(8%) had an improvement of ≥2 grades in the incidence and severity of MHA, 2 patients did not show any improvement of their MHA, whereas 1 patient reported a severe relapse of MHA about 1 year after the procedure. Conclusions: In patients with PFO, MHA is associated with spontaneous large R-to-L shunt and thrombophilic conditions. Transcatheter defect closure seems to be an effective and safe means to treat MHA in patients with PFO.展开更多
在成年偏头痛患者中,约有四分之一存在卵圆孔未闭的情况,研究表明,因右向左的房间血液分流,PFO与偏头痛之间可能存在相关性。尽管PFO封堵术已取得广泛应用,但不同研究对于PFO伴偏头痛患者在封堵术后缓解有效率仍存在争议。为筛选出可能...在成年偏头痛患者中,约有四分之一存在卵圆孔未闭的情况,研究表明,因右向左的房间血液分流,PFO与偏头痛之间可能存在相关性。尽管PFO封堵术已取得广泛应用,但不同研究对于PFO伴偏头痛患者在封堵术后缓解有效率仍存在争议。为筛选出可能获益的患者群体,以提高PFO封堵术后偏头痛缓解有效率及评估术后疗效,偏头痛相关缓解指标的研究则显得尤为重要。本文旨在对卵圆孔未闭封堵术后偏头痛缓解指标的研究进展进行综述。In adult patients with migraines, approximately one-quarter are found to have a patent foramen ovale (PFO). Emerging studies suggest a potential association between PFO and migraines, which may be attributable to right-to-left shunting of blood between the atria. Although PFO closure procedures are routinely performed, the efficacy of these interventions in mitigating migraine symptoms remains a subject of ongoing debate. It is imperative to identify patient populations that may derive benefit from PFO closure and to evaluate the outcomes following such procedures. Consequently, research focused on migraine relief indicators is of paramount importance. This review aims to synthesize the current advancements in the investigation of indicators of migraine relief after closure of patent foramen ovale.展开更多
文摘Background: Patent foramen ovale(PFO) has been implicated in the etiology of migraine headache with aura(MHA), but the mechanisms that link right-to-left(R-to-L) shunt to MHA are unclear, and the reports on the efficacy of transcatheter PFO closure on MHA prevention are scarce. Methods: We reviewed the clinical records of 131 consecutive patients who underwent successful transcatheter PFO closure at our institution at a mean age of 45±13 years because of cryptogenic stroke. Of the 131 patients, 35(27%) had a diagnosis of MHA made by the primary care physician or the referring neurologist. Migraine headache with aura incidence and severity were assessed by using Migraine Disability Assessment(MIDAS) questionnaire. Presence and magnitude of R-to-L shunt were assessed in all patients by means of transesophageal echocardiography and also by means of transcranial Doppler(TCD) in the last 50 patients(38%). Results: Patients with MHA had a higher prevalence of thrombophilia(P=.007), a more complex atrial septal anatomy(P=.001), and they also had higher prevalence of spontaneous R-to-L shunt and of spontaneous large shunt,both at transesophageal echocardiography(P=.015, and .028, respectively) and at TCD(P=.036, and .038, respectively). After the procedure, 32(91%) of 35 patients had either complete resolution or significant improvement in their MHA. At a mean follow-up of 1.7±1.3 years, MHA disappeared completely in 29(83%) of 35 patients. Of the remaining 6 patients, 3 patients(8%) had an improvement of ≥2 grades in the incidence and severity of MHA, 2 patients did not show any improvement of their MHA, whereas 1 patient reported a severe relapse of MHA about 1 year after the procedure. Conclusions: In patients with PFO, MHA is associated with spontaneous large R-to-L shunt and thrombophilic conditions. Transcatheter defect closure seems to be an effective and safe means to treat MHA in patients with PFO.
文摘在成年偏头痛患者中,约有四分之一存在卵圆孔未闭的情况,研究表明,因右向左的房间血液分流,PFO与偏头痛之间可能存在相关性。尽管PFO封堵术已取得广泛应用,但不同研究对于PFO伴偏头痛患者在封堵术后缓解有效率仍存在争议。为筛选出可能获益的患者群体,以提高PFO封堵术后偏头痛缓解有效率及评估术后疗效,偏头痛相关缓解指标的研究则显得尤为重要。本文旨在对卵圆孔未闭封堵术后偏头痛缓解指标的研究进展进行综述。In adult patients with migraines, approximately one-quarter are found to have a patent foramen ovale (PFO). Emerging studies suggest a potential association between PFO and migraines, which may be attributable to right-to-left shunting of blood between the atria. Although PFO closure procedures are routinely performed, the efficacy of these interventions in mitigating migraine symptoms remains a subject of ongoing debate. It is imperative to identify patient populations that may derive benefit from PFO closure and to evaluate the outcomes following such procedures. Consequently, research focused on migraine relief indicators is of paramount importance. This review aims to synthesize the current advancements in the investigation of indicators of migraine relief after closure of patent foramen ovale.
