[Migraine with aura and patent foramen ovale. A different clinical entity]

J M Ramírez-Moreno, I Casado-Naranjo, M Gómez, Jc Portilla, M Caballero, A Serrano, M J Ojalvo, A Falcón, D Tena-Mora, M Calle
Neurología: Publicación Oficial de la Sociedad Española de Neurología 2008, 23 (8): 503-10

INTRODUCTION: This work has aimed to evaluate the prevalence of patent foramen ovale in subjects with migraine with aura by transcranial contrast doppler and to describe the clinical and risk profile of these patients.

METHOD: We performed a transcranial contrast doppler in 94 consecutive out-patients with migraine with aura (MWA) in a neurology outpatient clinic. They were divided into two groups according to the presence of patent foramen ovale: MWA_RLsh (with right-to-left shunt) and MWA_RLNsh (without right-to-left shunt). Differences between the groups were analyzed according to endpoints of age, gender, clinical severity, aura type and attacks frequency, comorbility, cardiovascular risk factors (CVRFs), neuroimaging findings, severity of shunt and treatment.

RESULTS: n=94; MWA_RLsh: 47 (54%). MWA_RLNsh: 40 (46%). Age: 33.13; standard desviation (SD): 10.8 vs 33.496; SD: 11.2; p=0.728. Female: 66 vs 72.5%; p=0.511. Visual aura: 73.9% vs 78.9%; p=0.921. There were no significant differences in regards to the risk factors studied or to the comorbid diseases that are associated to migraine. The patients with patent foramen ovale have an odds ratio (OR) of ischemic stroke: 1.189 (95% confidence interval [CI]: 0.226 to 6.248; p=0.840), OR for subclinical brain lesions in cranial magnetic resonance imaging (MRI): 0.589 (95% CI: 0.193 to 1.799; p=0.35) and OR for combined previous ischemic stroke and subclinical brain lesions: 0.745 (95% CI: 0.261 to 2.129; p=0.58). Migraine attack frequency >1 per month: 27.9 vs 36.4; p=0.464. Need for prophylaxis therapy: 44.7 vs 57.7%; p=0.284.

CONCLUSIONS: Both groups are similar regarding their clinical profile. We did not find a greater prevalence of stroke or silent brain lesions in the group with positive shunt..

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