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Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study

G P Anzola1, M Magoni, M Guindani

  • 1Clinica Neurologica-II Neurologia, Brescia, Italy.

Neurology
|May 20, 1999
PubMed
Abstract

Insights

Patent foramen ovale (PFO) is significantly more common in patients with migraine with aura, suggesting a link to paradoxical embolism. This finding may explain the increased stroke risk observed in migraine with aura patients.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • A link between patent foramen ovale (PFO) and transient global amnesia (TGA) suggests paradoxical microembolization as a potential cause.
  • Migraine with visual aura involves cortical dysfunction potentially triggered by basilar artery issues, similar to TGA.
  • Investigating PFO prevalence in migraine patients may elucidate mechanisms linking migraine to stroke.

Purpose of the Study:

  • To determine the prevalence of PFO in a cohort of migraine patients.
  • To explore a potential mechanism for the association between migraine and stroke.
  • To compare PFO prevalence in migraine with aura versus migraine without aura.

Main Methods:

  • A consecutive, unselected cohort of 113 migraine with aura (MA+) patients, 53 migraine without aura (MA-) patients, and 25 age-matched controls were studied.
  • Patent foramen ovale (PFO) was detected using transcranial Doppler sonography with agitated saline injection.
  • Prevalence rates were compared between groups using statistical analysis, including odds ratios and confidence intervals.

Main Results:

  • The prevalence of PFO was significantly higher in migraine with aura (MA+) patients (48%) compared to migraine without aura (MA-) patients (23%) and controls (20%).
  • The odds of having PFO were 3.13 times higher in MA+ patients than MA- patients (p=0.002).
  • MA+ patients had a 3.66 times higher odds of PFO compared to controls (p=0.01), while MA- patients did not differ significantly from controls.

Conclusions:

  • Patent foramen ovale (PFO) is associated with migraine with aura (MA+), but not with migraine without aura (MA-).
  • The higher prevalence of PFO in MA+ patients may explain the increased risk of stroke observed in this population.
  • This suggests a potential mechanism of paradoxical cerebral embolism contributing to stroke risk in migraine with aura.

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