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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
Published on: June 2, 2014
Cardiac sources of cerebral embolism in people with migraine
V De Giuli1, M Grassi2, M Locatelli1
1Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy.
Insights
Migraine with aura (MA) is not linked to atrial fibrillation (AF) in stroke patients. However, MA may be associated with patent foramen ovale (PFO), particularly in younger women with fewer vascular risks.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- The link between migraine with aura (MA) and cardioembolic stroke is debated.
- Potential explanations include higher rates of atrial fibrillation (AF) or other cardiac embolism sources.
Purpose of the Study:
- To investigate the association between atrial fibrillation (AF) and patent foramen ovale (PFO) in patients with acute brain ischemia and migraine history.
- To determine if AF explains the MA-stroke association.
Main Methods:
- A single-center cohort study of consecutive patients with acute brain ischemia.
- Stratification by migraine status and analysis of AF and PFO associations.
- Included 1738 patients, analyzing demographics and cardiac conditions.
Main Results:
- No association was found between AF and migraine history.
- Migraine, especially MA, showed a significant association with PFO in the overall cohort and in patients ≤55 years.
- This PFO association was stronger in women and younger patients, but not in migraine without aura.
Conclusions:
- Migraine in brain ischemia patients is not associated with AF.
- A probable link exists between migraine, particularly MA, and PFO in younger patients, women, and those with better vascular risk profiles.
Background And Purpose:
Whether the reported association between migraine with aura (MA) and cardioembolic stroke may be explained by a higher rate of atrial fibrillation (AF) or by other potential cardiac sources of cerebral embolism remains to be determined.
Methods:
In the setting of a single centre cohort study of consecutive patients with acute brain ischaemia stratified by migraine status, the association between AF as well as patent foramen ovale (PFO) and migraine was explored.
Results:
In all, 1738 patients (1017 [58.5%] men, mean age 67.9 ± 14.9 years) qualified for the analysis. Aging was inversely associated with migraine, whilst women had a >3-fold increased disease risk (odds ratio [OR] 3.82, 95% confidence interval [CI] 2.58-5.66). No association between AF and history of migraine or its pathogenic subtypes was detected. Conversely, migraine was associated with PFO, both in the entire cohort (OR 1.84, 95% CI 1.07-3.16) and in patients aged ≤55 years (OR 2.21, 95% CI 1.16-4.22). This association was significant for MA (OR 2.92, 95% CI 1.32-6.45 in the entire cohort; OR 2.92, 95% CI 1.15-7.41 in patients aged ≤55 years) and in women (OR 8.23, 95% CI 2.06-32.77), but not for migraine without aura.
Conclusions:
In patients with brain ischaemia migraine is not associated with AF. Conversely, there is a probable relation between migraine, especially MA, and PFO in patients who are younger and have a more favourable vascular risk factor profile, and in women.
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