Migraine, patent foramen ovale and migraine triggers

• Published in: Journal of headache and pain Vol. 8; no. 1; pp. 7 - 12
• Main Authors: TEMBL, Jose, LAGO, Aida, SEVILLA, Teresa, SOLIS, Pilar, VILCHEZ, Juan
• Format: Journal Article
• Language: English
• Published: Milano Springer 01.02.2007; Springer Nature B.V; Springer-Verlag
• Subjects: Adult; Biological and medical sciences; Cardiovascular system; Case-Control Studies; Female; Functional Laterality - physiology; Heart Septal Defects, Atrial - complications; Heart Septal Defects, Atrial - epidemiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Migraine; Migraine with Aura - complications; Migraine with Aura - epidemiology; Neurology; Original; Pathogens; Pharmacology. Drug treatments; Prevalence; Traumas. Diseases due to physical agents; Ultrasonography, Doppler, Transcranial - methods; Valsalva Maneuver; Vascular diseases and vascular malformations of the nervous system; Vasodilator agents. Cerebral vasodilators; Doppler ultrasound study; Headache; Right-to-left shunt; Prevalence; Persistent fetal circulation; Sex; Migraine triggers; Cardiovascular disease; Vascular disease; Trigger; Pain; Respiratory failure; Heart disease; Valsalva manoeuvre; Valsalva manoeuvres; Neurological disorder; Aura; Triggering; Cerebrovascular disease; Sonography; Human; Nervous system diseases; Shunt; Respiratory disease; Migraine; Patent foramen ovale; Congenital disease; Pulmonary hypertension; Cerebral disorder; Newborn diseases; Central nervous system disease; Ostium secundum; Migraine with aura
• ISSN: 1129-2369; 1129-2377
• DOI: 10.1007/s10194-007-0359-x

Little information exists about a causal association between PFO and migraine. Some patients identify Valsalva-provoking activities (VPA) as migraine triggers. Therefore, we speculate about a pathogenic connection. The object of the study is to investigate the prevalence of right-to-left shunt (RLS) in a cohort of patients suffering migraine with aura (MA) and its possible association with migraine attacks triggered by VPA. We investigated the circumstances triggering the migraine attacks, in a consecutive series of 72 MA patients and in a series of migraine without aura age and gender-matched. The presence and extent of RLS was assessed by transcranial Doppler. Massive RLS appeared in 38.9% of MA and in 6.5% of migraine without aura (p<0.001). MA patients identified at least one VPA as headache trigger in 45.8%. A trend was found between these triggering activities and massive RLS, both in MA group OR 2.7 [1.02-7.17] and in all migraine patients OR 2.5 [1.01-6.11]. According to our results, patients with migraine who have larger RLS tend to recognize activities that increase the extent of the shunt as a trigger of their migraine attacks.