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Is migraine associated with right-to-left shunt a separate disease? Results of the SAM study

G P Anzola1, G Meneghetti, C Zanferrari

  • 1Service of Neurology, S. Orsola Hospital FBF, Brescia, Italy. gpanzola@numerica.it

Cephalalgia : an International Journal of Headache
|February 19, 2008
PubMed

Insights

Patent foramen ovale (PFO) and right-to-left shunts (RILES) may be linked to migraine with aura. While PFO closure might offer relief, this study found RILES effects on migraine features are not significant, suggesting a possible genetic link instead.

Area of Science:

  • Neurology
  • Cardiology
  • Genetics

Background:

  • Migraine with aura (MA) is frequently associated with patent foramen ovale (PFO).
  • Right-to-left shunts (RILES) through PFO are hypothesized to trigger migraine attacks.
  • Preliminary findings suggest PFO closure may alleviate migraine and aura symptoms.

Purpose of the Study:

  • To determine if shunt-associated migraine (SAM) exhibits distinct clinical features compared to shunt-unrelated migraine (SUM).
  • To investigate the relationship between RILES, PFO, and migraine characteristics in a large patient cohort.

Main Methods:

  • A prospective, multicentre, observational study (SAM study) enrolled 460 MA patients.
  • Patients completed standardized questionnaires on personal/family history and migraine features.
  • Systematic screening for RILES using transcranial Doppler and coagulation disorders was performed.

Main Results:

  • 42% of patients had SAM, while 58% had SUM.
  • SAM patients were younger, with more frequent family history of migraine and sensory aura symptoms.
  • SAM showed less association with cardiac abnormalities and coagulation disorders compared to SUM.

Conclusions:

  • The study suggests that the impact of RILES on migraine features is not clinically significant.
  • A higher prevalence of family history of migraine in SAM patients points towards a potential genetic linkage between PFO/RILES and migraine.

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