Cerebrovasc Dis. 2002;13(2):102-106
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.
Comment: Reach for the stethoscope/echocardiogram! This paper emphasizes the importance of physicians adopting a holistic approach to patients with migraine, not forgetting to check for clinical signs of a septal defect and, if in doubt, to refer for cardiological review to exclude a surgically treatable source of paradoxical emboli. DSM